CIGNA Questions...

[ckrbaird 6]

I've just started my Weight Watchers diet supervised by my PCP. I know that every plan is different but I'm wondering what experiences people have had with CIGNA; I have a few questions:

We are changing our insurance carrier and my CIGNA coverage doesn't actually begin until Jan. 1; the plan requires A 3 month supervised diet, will I have to start over on January 1? I will if I need to but hoping it counts now since the policy is a 3 month diet within a 12 month period.

Do I need to submit anything to begin with so they know my plans or do I just have my PCP and surgeon submit everything when I'm done and ready for surgery?

What do I need to submit of my diet? Do they want every day of documentation as proof? Will they just take my PCP records of visits, weight, program, & exercise?

Thanks for your help! ????

[Tobeornottobe 89]

I've just started my Weight Watchers diet supervised by my PCP. I know that every plan is different but I'm wondering what experiences people have had with CIGNA; I have a few questions:

We are changing our insurance carrier and my CIGNA coverage doesn't actually begin until Jan. 1; the plan requires A 3 month supervised diet, will I have to start over on January 1? I will if I need to but hoping it counts now since the policy is a 3 month diet within a 12 month period.

Do I need to submit anything to begin with so they know my plans or do I just have my PCP and surgeon submit everything when I'm done and ready for surgery?

What do I need to submit of my diet? Do they want every day of documentation as proof? Will they just take my PCP records of visits, weight, program, & exercise?

Thanks for your help!

You can start now. I started the process with United Healthcare and hubby and I both changed jobs and our health insurance changed to Cigna. My timeframe changed from 6 months to 3 months. So instead of having surgery in Feb/March of next year, I'm going in on December 9th.

When we moved to Cigna, I called Cigna and got them to email me the criteria and verified benefits, co-pays, etc.

As far as nutrition, WW and Jenny Craig are acceptable as long as you are supervised by a medical doctor. Cigna does not require a day to day accounting of what your diet. The nutrition component is mostly to know you are equipped with the information to make you successful after the surgery. Monthly weigh-ins are also required. I visited my doctor's office once a month to be weighed. My surgeon has nutritionists in his practice so I used them for documentation. Please note: Cigna requires 90 days of documented nutrition information, not 89 but 90. I did 4 nutrition visits to be safe.

These are the Cigna requirements:

Medical management including evidence of active participation within the last 12 months in a weightmanagement

program that is supervised either by a physician or a registered dietician for a minimum of

three consecutive months ((i.e., ≥ 89 days). The weight-management program must include monthly

documentation of ALL of the following components:

weight

current dietary program

physical activity (e.g., exercise program)

Programs such as Weight Watchers®

, Jenny Craig® and Optifast® are acceptable alternatives if done in

conjunction with the supervision of a physician or registered dietician and detailed documentation of

participation is available for review. However, physician-supervised programs consisting exclusively of

pharmacological management are not sufficient to meet this requirement.

• A thorough multidisciplinary evaluation within the previous six months which includes ALL of the

following:

an evaluation by a bariatric surgeon recommending surgical treatment, including a description of the

proposed procedure(s) and all of the associated Current Procedural Terminology (CPT) codes

a separate medical evaluation from a physician other than the requesting surgeon that includes a

recommendation for bariatric surgery

unequivocal clearance for bariatric surgery by a mental health provider

a nutritional evaluation by a physician or registered dietician

Here is a link to the current Cigna policy:

https://cignaforhcp.cigna.com/public/content/pdf/coveragePolicies/medical/mm_0051_coveragepositioncriteria_bariatric_surgery.pdf

Hope this helps and good luck!

[ckrbaird 6]

Thank you Tobeornottobe! This is very helpful and congratulations to you on your upcoming surgery!

Seems like a funny thing to be congratulating someone on but I know I will be so excited when the time comes!

[Tobeornottobe 89]

LOL it does seem a bit strange. You will be approved and it will all go swimmingly!

[Nora82 11]

With Cigna I would suggest seeing your doctor for weight loss for 4 consecutive months. They consider your first visit as the beginning of the 89 days and the last visit as the end of the 89 days. If you see the doctor for only 3 months they only count it as 60 days.

[lat72 38]

Can my supervised diets be only with my PCP, and not on WW?

[Tobeornottobe 89]

Can my supervised diets be only with my PCP, and not on WW?

Yes, your supervised diet can be with your PCP.