Cigna- Requirements and Timeline

[LessFee 61]

2 hours ago, Wickedwinner said:

I have Cigna and I was under the impression that the DS surgery is not covered by Cigna at this time (or wasn’t last year when I had the sleeve).


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I should clarify that I was approved for VSG! Sorry if that confused you! That said, is it that DS isn’t covered at all? Or is it that it’s excluded by your plan?

[LessFee 61]

5 hours ago, PeaceDove24 said:

This is so crazy. I'm trying to get the DS, so can't go with Henke since he doesn't do that- but I just talked to another Dallas/Fort Worth surgical center that told me (before verifying insurance) that Cigna has a 1 month diet requirement.

I'm just like. Y'all. Get your stories straight?

That is so weird. Scott, the coordinator at Dr. Henke’s office, is great! He emails you the requirements and goes over them with you before your first appointment. One of the first things he said was that Cigna didn't require a diet, and you only had to have one nutrition consult (which was true). And the letter from my doctor was really generic. She just said that I tried Weight Watchers, Atkins, and we had discussed my weight at her office. I definitely expected more hoops, but I didn’t get any!

[shauntaeb66 1]

I just finished my requirements for cigna and I'm getting the gastric sleeve. I was not required the 6 month or 1 month diet requirement. I was only required, 1 dietitian visit, 1 psychology visit , sleep study test and PCP clearance.

[vovo2013 35]

I have cigna and it only required 1 nutrition visit. I am also doing the sleep study. So, everybody is different with cigna and there own plan.

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[PeaceDove24 8]

20 hours ago, Wickedwinner said:

I have Cigna and I was under the impression that the DS surgery is not covered by Cigna at this time (or wasn’t last year when I had the sleeve).


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Interesting. On their Bariatric Surgery policy sheet BPD/DS is covered (seemingly).

The modified versions of it are not tho, due to being experimental.

[PeaceDove24 8]

I was also just told by a different practice that my insurance requires a 3 month diet/exercise program.

I can't figure it out.

[vovo2013 35]

I was also just told by a different practice that my insurance requires a 3 month diet/exercise program.
I can't figure it out.

Every Cigna plan is different! Not everybody has the same Cigna plan.

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[PeaceDove24 8]

14 minutes ago, vovo2013 said:

Every Cigna plan is different! Not everybody has the same Cigna plan.

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I understand. But Cigna has told me directly that they don't have a diet/exercise requirement for authorization. And that practice telling me 3 months is different than another practice that told me 1 month yesterday.

[LessFee 61]

2 hours ago, PeaceDove24 said:

I understand. But Cigna has told me directly that they don't have a diet/exercise requirement for authorization. And that practice telling me 3 months is different than another practice that told me 1 month yesterday.

I feel like these offices are telling you this because the office is low-key requiring it to make sure you get approved. When Cigna approves you (or denies you) they send out a letter that details the exact requirements for approval. Nowhere in there is there mention of a diet. This is weird.

[PeaceDove24 8]

4 hours ago, LessFee said:

I feel like these offices are telling you this because the office is low-key requiring it to make sure you get approved. When Cigna approves you (or denies you) they send out a letter that details the exact requirements for approval. Nowhere in there is there mention of a diet. This is weird.

Yeah. So I figured out the issue- the 3 month practice was saying 3 months so they would have proof of medical weight loss attempt.

The one month place said "1 month" but really only meant a single visit.

But now I have another issue altogether- I haven't actually ever done a medically managed weight loss program. I've seen various nutritionists, gone to weight loss camp, spent a 15 months working out with a personal trainer, done gym many times, majored in Nutrition in college and even started a medical management program with a specialist. I wonder if there is any kind of override way around that....

I just don't know if this is going to be able to happen for me. :/ At least not in the timeline I needed it to.

[LessFee 61]

20 hours ago, PeaceDove24 said:

Yeah. So I figured out the issue- the 3 month practice was saying 3 months so they would have proof of medical weight loss attempt.

The one month place said "1 month" but really only meant a single visit.

But now I have another issue altogether- I haven't actually ever done a medically managed weight loss program. I've seen various nutritionists, gone to weight loss camp, spent a 15 months working out with a personal trainer, done gym many times, majored in Nutrition in college and even started a medical management program with a specialist. I wonder if there is any kind of override way around that....

I just don't know if this is going to be able to happen for me. 😕 At least not in the timeline I needed it to.

I didn’t do a medically supervised diet either! Cigna doesn’t require one, and my surgeon only requires what the insurance requires. My PCP just wrote in her letter all of the things that I did try. That seemed to work just fine! Try not to count yourself out! I know you want the DS, but is there any way you could just do the VSG or RnY and go with Dr. Henke? His office is great!

[New&Improved 1,780]

Many more offices do RNY which isn't too different to DS, curious what made you feel you need DS? how much weight loss are you needing... There's heaps of information on here for you!

Edited May 24, 2019 by Mikeyy

[PeaceDove24 8]

On 5/24/2019 at 4:13 AM, Mikeyy said:

Many more offices do RNY which isn't too different to DS, curious what made you feel you need DS? how much weight loss are you needing... There's heaps of information on here for you!

I have 150-175lbs to lose.

I don't like the RNY due to dumping and large regain %. I also want to preserve and utilize the pyloric valve as well as completely removing the part of the stomach that Ghrelin comes from.

I had originially been looking at VSG because I knew I didn't want RNY- after watching several informational sessions (that only talked about Band, VSG and RNY), I literally thought to myself "I need the malabsorption of RNY and the stomach of VSG". I'm not even sure *how* I stumbled upon the DS, but since I realized it was an actual procedure, it's made the most sense to me.

[New&Improved 1,780]

9 minutes ago, PeaceDove24 said:

I have 150-175lbs to lose.

I don't like the RNY due to dumping and large regain %. I also want to preserve and utilize the pyloric valve as well as completely removing the part of the stomach that Ghrelin comes from.

I had originially been looking at VSG because I knew I didn't want RNY- after watching several informational sessions (that only talked about Band, VSG and RNY), I literally thought to myself "I need the malabsorption of RNY and the stomach of VSG". I'm not even sure *how* I stumbled upon the DS, but since I realized it was an actual procedure, it's made the most sense to me.

Yes the DS combines both surgeries but it is much more intense, will be made to take numerous Vitamins everyday 3x a day, you will risk malnutrition because of the extreme malabsorption, obviously you will lose quicker but there have been people on DS that have gone below their goal and ended up heading towards anorexia! The RNY is pretty much inbetween VSG and DS, I really hope you do more research before you make final decision!

Edited June 4, 2019 by Mikeyy

[PeaceDove24 8]

1 hour ago, Mikeyy said:

Yes the DS combines both surgeries but it is much more intense, will be made to take numerous Vitamins everyday 3x a day, you will risk malnutrition because of the extreme malabsorption, obviously you will lose quicker but there have been people on DS that have gone below their goal and ended up heading towards anorexia! The RNY is pretty much inbetween VSG and DS, I really hope you do more research before you make final decision!

I've done a ton of research. A good 50-75% of the people I've contacted that have had the RNY have either gained the weight back, or gone thru finding out they need to take a ton of Vitamins. It just doesn't seem like the best option- DS does.

Yes, it is more intense. Yes, I'll be on a strict diet and Vitamin regimen for the rest of my life. I will forever take steps toward not losing too much weight. I have a plan in place to try and keep that from happening.