Cigna and 6 mths of dieting?

lag1949 · September 14, 2007

thanks for the info, my bmi is 43, is that good or bad? this is all new to me

lwesson · September 14, 2007

HeyHon,

have u had any luck with cigna? i have been fighting with them since may this yr over the 6 month deal. My band dr assures me we have what is needed so i went ahead with the banding Aug 23rd and just received notice (again!) insurance denied surgery charges.... going to start the fight all over again with them this monday. anything u can offer as to EXACTLY what they are looking for would be very much appreciated

Big Fred · September 14, 2007

lwessn,

Cigna requires that you provide the following;

Six months of documented monthly Physician visits
Six months of Dr. supervised diet
Meeting with a dietician
Psychological review and sign-off
Pulmonology sign-off (possible sleep test if needed)
Heart specialist sign-off
Blood Work
Stress Test
Documented weight from a year ago
BMI over 40
Report on medical issues, such as; Sleep Apnea, Diabeties, High Blood Pressure, etc.....

I worked with the weight center coordinator, she steered me through the entire process. I recommend you do the same.

I know it sounds daunting, if you stick to it - it will get done. You will be amazed how fast the time goes by.

lag1949 · September 15, 2007

I was told you basically have to have like 6 letters, showing what diet you were on. how much you weighed and lost for the month. Then it is sumitted to the Insurance Co. Why did they deny You...Yikes that is scary.

heyhon63 · September 15, 2007

Good Luck Fred. I hope it is a positive quick response. I just found out I have to start my six month over.

jennypoo1 · October 2, 2007

Just Wanted To Say I Hate Insurance Companies!!!!!!!!!!!

lag1949 · October 2, 2007

I was told by by insurance co (Cigna) that you have to be on a supervised diet by a nutrtionist. The docor that is doing the bypass has a nutrtionist in his office. So it will be March or April before I can have the bybass

JulieC · October 3, 2007

<p>I join you in the six month diet plan! or game I feel. I am glad to know so many of you are in the same boat as I am. I have been slacking a little knowing I do not want to go beneath 40 BMI as I do not have real significant co-morbidities. Just hangin in there!<img src="http://www.LapBandTalk.com/images/smilies/hungry.gif" border="0" alt="" title="Hungry" smilieid="262" class="inlineimg" /></p>

suei · October 6, 2007

another delay, now the hmo is saying maybe 8-10 months, im so discouraged, but my doctor resubmitted to bsbc today, telling them that i am an excellent candidate....i have been pursuing this since May of 2005, so the hoops that i have to keep jumping through is wearing me down! which is i guess what they want to do.

Sooverit! · October 7, 2007

Dear Fred: How are things going?...you must be banded by now. Hope all is well. We are all with you.

ecgilb235 · October 9, 2007

My wife and I were banded om 10/5, Cigna is her primary through her job and Cigna is my secondary (BCBS TX is my primary which does not cover the procedure). We went through the six month program Cigna requires without much problem. The one thing we did find out that you have to keep up your monthly progress appointments, Cigna told us that if any were outside the 30 day window between each appointment we would have to start the program all over again. We submitted our paperwork and I got my approval within a week, my wife was initially denied due to paperwork not being recieved by Cigna, but with special consultaion we were able to get it worked out. The only issues I have had is since BCBS TX is my primary I had to route everything to them first so they could could deny the claim before Cigna picked it up. Best Wishes for All.

heyhon63 · October 10, 2007

Hi all, I know with cigna you DONT have to use the nutrtionist diet. You do however have to be evaluated by a nurtionist. Which I had. I am using w.w watcher program but seeing my pcp dr. But my sergeon made it easy, because in our folder he handed out at the seminar (which is another thing I had to do, but I think that was required by my surgion not cigna and I am very thankful for that. To anybody who hasn't gone, GO). Anyway he had a paper with all info to be filled out (lbs, date, ect) it has to be filled out by my pcp. She made six copies and fills one each time I am there.

ecgilb235 that is a good tip, thanks. I didn't not know that. I think I happen to be lucky I will double check with my dr. next time. I would rather wait a go an extra month then to turn it in to find out I was a few days off.

Big fred how is it going with you? Are you doing the waiting game now?

To everyone I know it seems overwhelming and we all want it done yesterday, but keep a positive out look and just keep your chins up (LOL I didn't mean it like that).

I am going into four mths and I am will to do the 6 mths part it will be the wait for ins response that will be killing me. So I am sure I will be coming back here cry and caring on, needing ya'll to tell me to practice what I preach! Take Care;)

Big Fred · October 10, 2007

heyhon,

I heard from the surgeon's office, I'm approved !

Will be banded on 10/25.

Please make sure you follow all the rules, the coordinator of the office took care of all the paperwork but I made sure that each month my PCP documented our diet - weight loss conversation, my BP, weight and forwarded all to the surgeon's office.

Don't let more than 30 days between PCP visits go by, Cigna is a stickler for the monthly visits. Also make sure that the surgeon provides a letter of medical necessity, my surgeon sent it along in my paperwork but for some reason they misplaced it and it had to be faxed over to them again.

It was a nail bitting 3 weeks but I got through it, now I'm on the road to another part of my life.

I'll keep posting as things progress. My prayers and thoughts to everyone waiting in the insurance twighlight zone.

heyhon63 · October 10, 2007

:whoo::clap2: Waahooo! Good for you Fred! I am so happy for you! How exciting! I have an appointment with my sergion Friday. Just to go over every thing. I will keep you in my prayers that all goes smoothly. I am glad you had no set backs with cigna!

Good Luck! :rolleyes:

JackieMorris · October 14, 2007

I just started researching and am liking what I'm finding out about the lap band. My primary care doc was positive about it but didn't like the idea of going to Mexicao, so I checked with my insurance co. (Blue Cross/Blue Shield, through my husband's former employer---he's retired)

The good news is that my insurance policy does cover lap band surgury, and I generally do fit the criteria....40 BMI or 35 with premorbid conditions. I qualify both ways. I have a 40 bmi, and high blood pressure and high cholestrol

but

It says I have to have been on a doctor's diet for 6 mo prior.

So where does this put me. I am VERY GOOD at loosing weight. I've lost the same 70-80 lbs, sensibly, at least 4 times! The problem is I have always regained it, with more weight! If I go on a diet for 6 months, I'm pretty sure I will loose a lot of weight....probably 40 lbs. or more, which would then make me inelligible for surgery! Of course, the weight will more than likely come back again....as it always has. How do I get around this catch 22?

O, and my weight loss programs have never exactly been under a doctor's supervision. The last attempt was the zone, and I actually kept it off for 3 years, but eventually it did creep back....plus about 20 more lbs. My doctors have always been very happy about my weight loss attempts, but I've never been in a supervised program...Just researched a lot.