CIGNA - supervised diet requirement

[nightcheese 3]

Hi, all!

I am just beginning my journey to surgery, officially - I attended my surgeon's seminar last week and have my PCP appointment tomorrow for him to sign off on the surgery.

Anyway, I have Cigna insurance and I know I meet all the requirements for them to cover me (I just spoke with someone at Cigna). Just have one question and was hoping someone could help.

The "physician supervised" weight loss program/diet/nutrition/exercise portion of the requirement -- here's what they say:

"Medical Management including active participation within the last 12 months in a weight-management program that is supervised by a MD/PA/NP or RD for a minimum of three consecutive months (>89 days). Must include monthly documentation of the following - weight, current dietary program & physical activity (e.g. exercise program)."

In 2015 & 2016 I had a gym membership (I do zumba 3x/week usually) and attempted weight watchers for several months each year, and also did the Atkins diet for awhile. My PCP knows I was doing these things and knows I was trying to lose weight on my own, but he wasn't specifically "supervising" me (as in, I wasn't going to monthly appointments to weigh in or anything).

As part of my bariatric program, I will be required to meet with the RD at the bariatric center 3 times (each one month apart) in the upcoming months.

So, I guess my question is - whatever I've done in the past won't "count", correct? Since my PCP wasn't seeing me monthly?

Will the upcoming appointments I have with the RD be sufficient to satisfy Cigna's requirement?

What I'm worried about is that I'll have to do 3 months with my doctor before I can start doing the pre-op bariatric program at the center.

Thoughts?

Thanks in advance!!

[theantichick 2,204]

It didn't count for me with Cigna unless a doctor was weighing me in once a month. They had me see a doc for it while we worked on the other requirements.

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[cdeisroth 420]

I didn't have cigna but I had a similar requirement. The 3 months with my bariatric center is what counted, starting on my first date with the nutritionist. For me it went like this

Late January- appointment #1

Mid February- appointment #2

Early March- appointment #3

Surgery date was 3/14/16

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[Vinasu 621]

I had Cigna and I had to start counting from my first appointment with the nutritionist.

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[nightcheese 3]

Awesome, thank you! Hats what I was hoping for Was your approval pretty smooth with Cigna? I have only dealt with them briefly for my daughter's surgery last year, but she was a toddler and it wasn't something that needed pre-approval.

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[FDclerical 318]

I have cigna and I actually went in for a revision and they approved me 100%.

Oct 19th. Nov. 11th and Dec 8th were my NUT appointments. I don't even think it was a full 90 days that I did lol.

Your stuff prior is not going to count. But your doc should still let you get all your other pre op requirements out the way while on your supervised diet program for sure !!! My approval was smooth too it took like 7 days and all the reps were very very helpful. Good luck I'm sure u will be fine especially if medically necessary! !!!

foreverbariatric

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[areadyloser 31]

I have Cigna also. Process was simple and straightforward. I had to complete a 90 day medical supervised program and have a psych approval. I saw a dietician, exericise physiologist each month and had to weigh in. I only saw the Dr. at the beginning of the 90 days and at the end. The staff at my Bariatric office knew my requirements and made them clear to me. My 90 days started the day of my first appt with dietician and weigh-in.

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[Sparkles21 35]

I have cigna and went through the nutrition office that knew all the requirements (everything you've stated). You can use your pcp but he needs to state everything cigna requires and it has to be with the last 12 months. I'm waiting on my approval now! Everything was submitted on mon of this week. So nervous, anxious, excited, impatient!!

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[LucyLupus 0]

@@cdeisroth my Surgeon is saying the first appointment I had with my doctor doesn't count and that I need 3 after the first visit. Also, did you lose weight on the medically supervised diet?

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[Newme17 3,444]

@@cdeisroth my Surgeon is saying the first appointment I had with my doctor doesn't count and that I need 3 after the first visit. Also, did you lose weight on the medically supervised diet?

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That's technically correct. The first appt doesn't really count. I too have Cigna and have all the same requirements. My first appt with the nutritionist is when it started. I have three more to finish. For a total of four. When you think about it, the first to second appt, is one month. The second to third is two months and the third to fourth appt is three months. But if your pcp was documenting your weight loss attempts for a consecutive three months (four appts) than that would count. I went from March to December, but none of the documented appointments were consecutive, so I'm just starting over at the surgeons office.

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[cyninaz 26]

I have Cigna, and started fresh with nutritionist visits (a total of 4 visits), had a psych eval, PCP medical clearance and recommendation letter.....I was so worried I wouldn't be approved. However I was approved the first time around. Surgery scheduled for April 17! Some people had me worried with Cigna, but so far I haven't had any issues at all.

[kar12345 74]

Cigna here also. 4 months from start to surgery. September kicked things off with the Bariatric program information session and scheduled my first nutritionist appointment the same week. I did the same thing and checked with Cigna on the requirements. Cigna said I could do 3 months supervised diet with a nutritionist and they gave me some names of those in their network. I had to do at least one nutritionist visit with the Bariatric surgeons office, but it was not close to my home. So I picked a nutritionist close by to meet with me 4 times (September, October, November, and December), and she documented my diet, exercise and weight. In parallel, my surgeon let me do all the pre-op appointments and tests. So timing wise, it worked out well and i had my nutritionist send my 3-month supervised diet chart notes to the surgeon immediately after my 4th appointment. By that time, I completed all the other Cigna and surgeons prerequisites and just needed the last piece from the nutritionist. Paperwork submitted week before Christmas, and approved in one week!!!! Then was able to schedule surgery mid-January. I will say it was a very very busy time, particularly because I also had to get appointments and clearances from 4 other specialists. So right away I started scheduling those. In the end, the 3 months worked out to be just the right amount of time to fit everything in ( oh and work full time and have a family, etc). So knowing your insurance requirements up front is the best thing to do!!! Best of luck!!