What does "significant gaps" mean with Cigna?

readytoloselbs · March 17, 2008

Hi everyone, this is my first post and hoping you can shed some light on what I can expect from Cigna. My paperwork was submitted approximately ten days ago and I am nervously awaiting the results. I wanted to know if anyone knows what "significant gaps" means as it relates to the six-month PCP diet requirement. I saw my PCP in 2/07, 4/07, 6/07, 7/07, 8/07 and

9/07. I have a BMI of 41 and I got clearance from all the necessary specialists (psych eval, nutritionist, etc.). If this is not enough, I have documentation from Jenny Craig, gym memberships, Weight Watchers, etc. but did not submit this with my original paperwork. I have called to check the status every other day and my case is still in review? My doctor told me that it is good that I have not rec'd a denial and that it is still in review. What are your thoughts on getting approved since my visits were not consecutive based on your experience? I value your input. Thanks.

MirandaK · March 17, 2008

I think you may have to redo the six months because I am 3 weigh-in in and they have to be every 30 days.You can only go out 5 days from the 30 days or you start over. Also Jenny Craig or Weight Watcher does not count. But you never know I get told every month it is always on a case by case bases. Good Luck!!

Hi everyone, this is my first post and hoping you can shed some light on what I can expect from Cigna. My paperwork was submitted approximately ten days ago and I am nervously awaiting the results. I wanted to know if anyone knows what "significant gaps" means as it relates to the six-month PCP diet requirement. I saw my PCP in 2/07, 4/07, 6/07, 7/07, 8/07 and
9/07. I have a BMI of 41 and I got clearance from all the necessary specialists (psych eval, nutritionist, etc.). If this is not enough, I have documentation from Jenny Craig, gym memberships, Weight Watchers, etc. but did not submit this with my original paperwork. I have called to check the status every other day and my case is still in review? My doctor told me that it is good that I have not rec'd a denial and that it is still in review. What are your thoughts on getting approved since my visits were not consecutive based on your experience? I value your input. Thanks.

cathychatts · March 17, 2008

I also have Cigna and wanted to know the answer to that question also. I have about the same documentation as you, I went to my PCP in Jan, Feb and March, she put me on Phentramine and then I went to a medical led program called "loose it for good" for 4 months. I hope that will qualify, I still have the individual nutritionist visit and the gallbladder scan and one support group meeting this week and then I suppose they will submit for approval. I am so anxious to get this along!

TRN87 · March 17, 2008

I also have Cigna. I have my consultation on April 4th and am very excited. I didn't know Cigna required 6 months of dieting with a nutritionist. I spoke with a lady from my insurance company and she said that I had to have my BMI for at least a year and that was all. What all does Cigna require because obviously she didn't give me all the info.

Thanks:huh2:

MirandaK · March 17, 2008

I had to have a psych eval, a visit to a nutritionist, and a one year weight history, and six month doctor supervised weight loss program. Your policy may be differant and you may have to have a five year weight history and two visit to the nutritionist. Also bmi above 40 or 35 with one weight related issue.

readytoloselbs · March 18, 2008

Thank you everyone for your reply. I think I will make a doctor's appt. this month and get started on my six month process just in case. I have heard so many different things re: waivers on initial requirements or approval based on other information, including a peer review from my surgeon. There is no doubt we can all prove that I would benefit from the surgery :> I called Cigna today to check the status of my file and they escalated it after I spoke with a supervisor. They said that it has been assigned to a nurse and in review. I should hear something in approximately five days. I will let you all know how it goes. Thanks for being a great support group already :>