Cigna Approval Problem - Please Help

December 23, 2004

Hello Everyone -

My name is Linda and I am in the process of trying to get lapbanding approved through my Cigna Open Access Plus policy. Under my policy it must be proved that it is a medical necessity, and unfortunately I have many of the co-morbidities on the list including diabetes, hypertention, severe sleep apnea, depression, and neurological complications due to my diabetes which has left me wheelchair bound. Currently, I am on my first appeal, but will follow through to the end if necessary.

I am having all the same problems mentioned in so many of you about Cigna - but the most frustrating is that they say lapbanding is experimental. My surgeon has agreed to do a Peer - to - Peer review with Cigna, but his office is giving me grief that "Cigna never approves lapbands". As if it isn't enough to fight the insurance company, now I have to fight with the doctor's office too.

So that's where I need your help. Is anyone willing to send me an email with information about where and when Cigna approved their lapband? I am in desperate need of this information quickly to pass on to my surgeon. I wish to give him as much information as possible, and hopefully in the process educate his insurance co-ordinator that not all is as Cigna states.

You may feel free to email me at lilithwild@hotmail.com or answer directly on this thread. Thank you so much for any help or advice you may provide.

Denied but not giving up!

Linda in Illinois

leatha_g · December 23, 2004

This is not a clear cut issue, really. Cigna definitely does approve the lapband, but this is not really in Cigna's hands. Every employer purchases a unique policy. Some include weight loss options, some clearly do not. You need to read your own policy or call Cigna with the ICD9 Code used in banding and ask them if YOUR particular group policy approves this type of surgery.

In my case, I had Cigna PPO with my first banding surgery. I was approved first try and within a week of their receiving my paperwork.

I changed to Cigna EPP the following year and was rebanded due to slippage and they approved this surgery as well. No problem.

It simply has to do with what your own company's policies are. Some employers simply did not choose to have weight loss efforts included in their coverage. This is where you have to start. I wish you luck!