Cigna- requirements for approval

[Cjackson82 39]

Hello, this is my first post so I'll start by telling a little about myself. I'm 35 years old , mother of 1. Married for 3 years to my wonderful husband who is super supportive of my choice to have WLS. I'm currently working on the list of items needed for approval. I have chosen to go with Cleveland Clinic in Weston FL. My surgeons name is Dr Szomstein. I have a BMI of 38.9. I have been diagnosed with high blood pressure and i have been taking 1 medication. I am also pre-diabetic. The insurance specialist from CCF advised having the co-morbidity of hypertension with 1 medication would not be sufficient and I would need to have a minimum of 3 blood pressure meds to use that as a co morbidity. When I call cigna they say it does not specify how many meds I would need to be on to be considered. Has anyone has a similar situation? How did it go? Please share your story. Thank you!

Edited October 29, 2017 by Cjackson82

[trailtramper 107]

I have Cigna and though I have a higher BMI and did not require a comorbidity. The requirement is that your hypertension is poorly controlled with optimal medical management. Maybe the CCF insurance specialist or your doctor can explain why she thinks that. I would probably ask the doctor. The specialist is probably getting that from the CCF’s guide. http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/nephrology/arterial-hypertension/

Another surgeon may not define it the same. Here is the latest Cigna guide https://cignaforhcp.cigna.com/public/content/pdf/coveragePolicies/medical/mm_0051_coveragepositioncriteria_bariatric_surgery.pdf

[Cjackson82 39]

Thank you so much for your feedback. I really appreciate it!

[Mrs.2252 11]

I also have Cigna. I have high BP and am on 1 medication. I also have high cholesterol. My BMI is 36.8. I got my approval today.

[Cjackson82 39]

Thank you so much! You have given me hope. I just got my test results from the blood work the surgeon requested and the test indicates I also have high cholesterol. Thank you so much for the info. When is your surgery date? Also did you have to do 3 (at least 91 days ) or 4 months of nutrition classes?

[Mrs.2252 11]

My surgery date is 11/29. I ended up taking 8 classes. I only needed 3 months but my drs office required 4 and I had to start over because I missed one. Lmao long story. So after 1 full year I’m finally having surgery. Now that I think about it I’m glad I was extended a year. Now more than ever I know I’m ready.

[Cjackson82 39]

Aww congratulations!! I’m so happy for you!! I was warned if I miss one Cigna would make me start over. Lol. Thank you so much for all the information. I appreciate it!!