Finally !!! Approval from Cigna

[time2lose 0]

I just wanted to share my experience with Cigna in an effort to help others. I have been reading the many posts regarding Cigna and I have to agree that they are very difficult to work with in regards to customer service and follow up. My BMI is 41 and I have been overweight for more than five years. I completed my 6-month supervised diet in September, 2007. My months were not consecutive. I saw the doctor four consecutive months (June, July , August and September) but at the beginning of the visits, I skipped two alternate months (went in February, skipped March, went April, skipped May). However, it was six months. I had to wait on my psych evaluation and then my paperwork was submitted to Cigna on 2/7/08. I called on 2/8 to make sure the paperwork was received. I told them that I needed my file expedited because my sugery date was scheudled during a time that I could take off of work. They said they would do this and that it would take 15 days. I called and called and on 3/7/08, I found out that my paperwork was sent to the wrong department and had just been sitting there. I was livid. On 3/7/08, I spoke to a supervisor and he told me that he would make sure the paperwork was expedited and it would take ten days. I told him that I should not have to wait ten days due their error. He agreed and told me that he would see what he could do to speed up the process. I told him that I wanted to speak to someone in the pre-determination department and he told me that they do not have contact numbers. He said that he would be in contact with me and that I should hear something very soon. I gave them about a week. I then started calling everyday. My last conversation

with customer service was on 3/20/08 and I told them that I am going to write a letter to the head of Cigna with all of my documentation and include the names of the people I had spoken with, times and dates. I was so upset. Yesterday, 3/21/08, I got a call from my surgeon to let me know that I had been approved. My surgery date is 4/3/08. It is ashamed that we have to go through all of this but my advice is to follow up everyday if you have to, keep a log of who you speak and the time. Also, do not hesitate to escalate to the supervisor (even if they cannot do anything). I think the whole customer team knew who I was :> Be persisitent and it will pay off. Good luck to everyone.

[Carrie_C 9]

Hi, thanks for sharing your story. I also have Cigna and I am waiting on approval. My paperwork was just sent in this past Thursday. I really don't understand why some people are approved within days and others have to wait months. It makes no sense to me. The surgeon's office told me to wait about 2 weeks and then start calling. So that is what I am going to do. Good luck with your surgery!

[cathychatts 1]

I hope to have everything ready for insurance on Wed. I will have the gallbaldder then. I have done all the information meetings, nutritionist, phyc eval., sleep evaluation, group meeting, pap, mamogram, I have 5 months in a doctor supervised program and 3 months with my general doc when she gave me phentramine. I pray that is enough!:tt1: I have a BMI of 41 and have sleep apnea, osteoarthitis in the knees, gerd and asthma. Surely I will get approved! Good luck to you, I am always happy to see someone approved.

I finally toldy my Boyfriend about this and I was shocked that he was so supportive. I expceted him to be a problem.:wub: His only concern was he wants to loose weight too.:thumbup: I told him I was afraid to tell him in case he only liked "fat girls" :wub: Silly me. :crying:

[TRN87 0]

Thanks for the info. I have a question...do you have to have at least a 40 BMI for 5 years or just be "overweight"? I have my consultation in 2 weeks, but just am worried I will not get approved for this! I have a BMI of 42, but no co morbidities and my weight has been up and down for years, so I have not had a steady BMI of at least 40 for 5 years.

Im so worried this wont work out...

[Carrie_C 9]

I think you just have to have a BMI of 40 for 1 year. That is what my insurance papers say anyway. But even if it's not exactly a year, I don't think they really check. Good luck.

[n8vtxn 0]

I have cigna, too, and I'm a little confused about their requirements. Like the 6-month diet eval, what does that mean? And do they cover seeing a nutritionist or whatever? Plus, I am at a 40 BMI now, and if I lose much in that 6-months, does that preclude me from the surgery altogether? I know my ultimate goal should be to lose weight and not get surgery, but lets be honest, I wouldn't be this overweight if I could do it on my own. And I am really concerned that if I don't get the band and lose enough to not get the band, I may end up yo-yoing back up and gaining more.

Does that make sense?

[stacey4870 0]

Hi I also will have Cigna ppo as of April 1st, I have a bmi of 50 with comorbidities such as high blood pressure, sleep apnea ( sleep with cpap) gerd,clogging arteries of legs, and risk of cardiac disease CRP levels elevated, i wonder what my chances are? Do they make everyone do the 6 mo dr supervised diet? And what if you loose weight, does that mean they wont approve you sine you can do it on your own? Thanks Stacey

[Carrie_C 9]

Yes, I believe everyone has to do the 6 month diet regardless of BMI. If you lose below 40, I don't know if they would still approve it, I doubt they would. They did not cover anything for my nutrition or psych eval, I had to pay that out of pocket. Stacy, your chances sound pretty good for approval if you do the 6 month diet. I would go ahead and start it if I were you, it goes by pretty fast. I think they actually WANT you to lose weight during the 6 months, because that shows that you are willing to lose it. The insurance cooridinator told me they want you to lose 10% of your body weight. I have met all the requirements and I am just waiting on them to decide if they will approve it. Waiting on approval is the worst part!!

[ShellShock 0]

I am currently doing my 6 month physician supervised diet. You need to see your doctor before you start the diet and each month during it for documentation. Make sure they write down that this is why you saw them. The insurance will want to see all vitals and your weight on the paperwork too. At the end you will submit seven visits to your insurance.

Cigna paid for my Psych Eval and my Nutritionist visit. The nutritionist is complicated though, they have to bill it a certain way for them to pay for it though. I had a problem at first and when I explained that it was a prerequisit for the surgery they approved it.

Don't let the customer service people throw you off track. I have called them a dozen times to verify my insurance to make sure things are covered and that I am doing this right and each time I call I get a different answer. So you need to ask for their policy for bariatric surgery in writing and read it yourself.

As far as weight loss during the diet. My surgeon requires us to lose 10% before surgery so that is my goal during this diet. I have asked every person I have spoken to at the sugeon's office and the nutritionists office and they all have said that even if you lose during your diet the insurance will look at your starting weight and BMI from your first surgeon's visit. Some insurances even require you to lose or they won't approve you. I don't think cigna has they rule though.

Good Luck all!!!