Starting process with Cigna

[sara_bear 8]

Hello all!

I am just starting my journey and have decided to have the gastric sleeve surgery. I have been overweight all my life, BMI is currently about 47. I have Cigna Open Access Plus through my employer. My first visit with the surgeon is on Monday morning, so I am hoping they will have more details there and that they have worked with these insurance requirements before.

Does anyone have any tips for me with getting approved with Cigna? How much weight did you lose on the 3 month supervised diet? I know that gaining is a no-no, but I am worried that if I happen to lose "too much" in their eyes, they will think I don't need the surgery. Was anyone approved on the first try? I see a lot of people being denied in the beginning. Any other advice would be much appreciated! I am so ready to get my health back on track and take this step to be able to enjoy the rest of my life.

[Newme17 3,444]

I have Cigna open access as well. It was pretty easy actually. The insurance will go by the first initial weight that the doctor reports. So even if you do gain (which I hope you don’t) you’ll still be able to get your surgery as long as the other prerequisites have been met. I started at 266 and by surgery I was 259, not much loss but it was okay. I lost those few pounds during my pre-op diet. My advise to you is to call cigna and stay on top of what needs to be done, etc. stay on top of your team and ask when they’ll be submitting paperwork, etc. in turn when they do, call cigna again and ask if they’ve received them, etc. I did all of that, my paperwork (after all was said and done) was submitted on a Thursday morning and I was approved the following morning. May not work for everyone but it sure does help to know what’s going on.

Blessings to you on your journey hon!

[carolinagirl14 1]

Hello all!
I am just starting my journey and have decided to have the gastric sleeve surgery. I have been overweight all my life, BMI is currently about 47. I have Cigna Open Access Plus through my employer. My first visit with the surgeon is on Monday morning, so I am hoping they will have more details there and that they have worked with these insurance requirements before.
Does anyone have any tips for me with getting approved with Cigna? How much weight did you lose on the 3 month supervised diet? I know that gaining is a no-no, but I am worried that if I happen to lose "too much" in their eyes, they will think I don't need the surgery. Was anyone approved on the first try? I see a lot of people being denied in the beginning. Any other advice would be much appreciated! I am so ready to get my health back on track and take this step to be able to enjoy the rest of my life.

Honestly I went through all that with insurance and turned down because my BMI wasn’t high enough and I had no medical issues. It was a huge waste of time. Last week I went to Mexico and paid for the sleeve out of my pocket. Best thing I’ve ever done. I should have done it years ago. Amazing surgeon and healthcare treatment. I know the journey will be long and hard but I am ready for it. My advice don’t waste a lot of time with insurance companies if it is what you truly desire. Good luck.

[Newme17 3,444]

4 hours ago, carolinagirl14 said:

My advice don’t waste a lot of time with insurance companies if it is what you truly desire. Good luck.

Sometimes it’s the only way for others, such as myself and I desired it. I met all the criteria for insurance and waiting a few months was nothing, it was very effortless and it was way cheaper than even going to Mexico to pay for it.

[purple22186 1]

I have Cigna.. The 3 months was not bad I just had to go to the gym and meet with a dietician..

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[it'sonlythefirststep 141]

We finally have insurance that will cover surgery. We had Cigna, Aetna (both said no) and now finally BCBS will cover!! So frustrating

[sara_bear 8]

I have Cigna open access as well. It was pretty easy actually. The insurance will go by the first initial weight that the doctor reports. So even if you do gain (which I hope you don’t) you’ll still be able to get your surgery as long as the other prerequisites have been met. I started at 266 and by surgery I was 259, not much loss but it was okay. I lost those few pounds during my pre-op diet. My advise to you is to call cigna and stay on top of what needs to be done, etc. stay on top of your team and ask when they’ll be submitting paperwork, etc. in turn when they do, call cigna again and ask if they’ve received them, etc. I did all of that, my paperwork (after all was said and done) was submitted on a Thursday morning and I was approved the following morning. May not work for everyone but it sure does help to know what’s going on.
Blessings to you on your journey hon!

Thanks so much for your detailed response!! I spoke to my surgeon’s insurance guy (I forget his official title) and started the process. I have an abdominal ultrasound and some x days booked on Thursday I assume to just check out my anatomy, I also have an umbilical issue that might need to be cleared up surgically so that may be why also. Then I have my psych evaluation on Friday - which seems rather soon to me, but I guess better to get it out of the way?! Waiting on the dietician to call me to set up an appointment. I’m hoping that I won’t need to see a cardiologist, but will see. So much happening at once!

[sara_bear 8]

We finally have insurance that will cover surgery. We had Cigna, Aetna (both said no) and now finally BCBS will cover!! So frustrating

That sounds awful! So glad you found a company that will cover. You’d think by now they would realize how much money they save by reducing obesity and not make things so difficult.

[sara_bear 8]

I have Cigna.. The 3 months was not bad I just had to go to the gym and meet with a dietician..

Sent from my LGL82VL using BariatricPal mobile app

Do you mind me asking how much weight, if any, you lost in those 3 months?

[purple22186 1]

Do you mind me asking how much weight, if any, you lost in those 3 months?

I lost 20lbs but I ended up gaining it back before surgery...

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[Frankette 95]

I have cigna and did 6 month program because that was what my surgeons group does. So I had basically double what cigna needed me to do. I did upper GI , 6 nutrition classes, psych eval and my surgeon required me to lose 5% of body weight during my 6 month but they submit starting weight when submitting to insurance.

Cigna denied me 2 times and went to peer to peer. My surgeons coordinator could not get a straight answer from them and they finally gave a bogus reason... I needed a 3 month exercise log. So I went on computer and made one up for the dates they asked for. Then I was approved. It was a stressful month of back and forth with cigna.

Im so glad to be on the otherside. I went to my first info seminar in Jan 2017 and got my surgery Dec 4th 2017. Last year was a long tough year. This year is going to be amazing.

[sara_bear 8]

I have cigna and did 6 month program because that was what my surgeons group does. So I had basically double what cigna needed me to do. I did upper GI , 6 nutrition classes, psych eval and my surgeon required me to lose 5% of body weight during my 6 month but they submit starting weight when submitting to insurance.
Cigna denied me 2 times and went to peer to peer. My surgeons coordinator could not get a straight answer from them and they finally gave a bogus reason... I needed a 3 month exercise log. So I went on computer and made one up for the dates they asked for. Then I was approved. It was a stressful month of back and forth with cigna.
Im so glad to be on the otherside. I went to my first info seminar in Jan 2017 and got my surgery Dec 4th 2017. Last year was a long tough year. This year is going to be amazing.

So glad you got it all straightened out!! I can’t believe how much crap they throw at you, even after submitting to all their demands! Thanks for the info!

Good for you for roughing it out and making this change for your health and happiness. Wishing you a speedy recovery and a great year ahead with the new you!

[Newme17 3,444]

On 1/16/2018 at 5:47 PM, sara_bear said:

Thanks so much for your detailed response!

You’re welcome hon. I had my psych evaluation early on too, I think within the first two weeks of my journey. There will be numerous appointments, but it’s all worth it IMO. Be blessed!

[sara_bear 8]

You’re welcome hon. I had my psych evaluation early on too, I think within the first two weeks of my journey. There will be numerous appointments, but it’s all worth it IMO. Be blessed!

Thanks so much! It’s great to know other people had similar experiences.

I had abdominal ultrasound and chest x-ray today, psych evaluation is tomorrow, my first nutritionist appointment is on Sunday, and then I see the surgeon on Monday!! Sure seems like a whirlwind, but it will be nice to pretty much only focus on the 3 month nutrition and exercise requirement and get all this other stuff out of the way.

[Newme17 3,444]

16 hours ago, sara_bear said:

Thanks so much! It’s great to know other people had similar experiences.

I had abdominal ultrasound and chest x-ray today, psych evaluation is tomorrow, my first nutritionist appointment is on Sunday, and then I see the surgeon on Monday!! Sure seems like a whirlwind, but it will be nice to pretty much only focus on the 3 month nutrition and exercise requirement and get all this other stuff out of the way.

Oh yes, absolutely, because the 3 months of exercise/nutrition is pretty hard, IMO. Taking the first steps to change what got most everyone there is a mental challenge. I’m over 8months post and I still deal with head hunger, etc. BUT beating those challenges are still all worth it for our health.