Believe it or not I rushed into this

[Sooverit! 1]

It's taken me almost a year and a half of work but it's over at least. This...meaning insurance approval with Cigna. I was Denied because I was shy a 40 BMI by 10 -12 pounds when I submitted everything they were looking for I jumped thru every hoop and paid out every last cent to docs. etc. but I should have know (and not listen to people on this site that said Cigna does cover with no co mobidities - NOT TRUE) they clearly state that they do not cover those under a 40 BMI unless you have grave illness that don't respond to meds.. Not only that but they will not approve any claim even related to this one in the future. Meaning if I gain 10 pounds in the next year.even if I maintain that for a year and..easy to do at my age...they won't even consider it.

My fear is of dying of a heart attack like my twin sister did of obesity last year. My chest is so huge it strangles me at night and causes sleep apnea that doesn't appear on the "test" ...another few hundred bucks there.

My warning to those seeking insurance approval with CIGNA....if you're not starting out with a 40 BMI save your money until you are or get a loan unless you can clearly prove a comobidity.

[ReadySteadyGo 8]

I'm sorry for your trouble.

[Carrie_C 9]

I finally got approved by Cigna as well. I agree with you, it is hard to get them to cover it if you don't have comorbidities. It is also hard if you do. I don't understand how some people get approved in only a few days.

[Chris61 0]

Glad to see that you got approved. Just like things in life, everything is differant and including insurance. I was surpised how quickley I was approved with UHC. I was done within less than 30 days. I will say it took me about 4-6 months to get it all in line and ready for the doctor to submit. This will be one of the many best things you have done for your self.

Chris

[Sooverit! 1]

I appologize if this is a dupe ...Not sure if my second post showed up. Re. being denied by Cigna, I meant to say that be sure you have a co mobidity with Cigna that they approve of. I had over a half dozen but they are currently managed with meds. Also some folks who have a BMI of 40 still get denied. I may appeal but just don't want the costs and headaches right now.

[jena 0]

Honestly, it's not the insurance company, it's the coverage that is selected. If you are covered by your or your spouse employer, it's really the fault (if it's anyones fault) of the employer. The company chooses the coverage, the co-pays etc. and it's based on cost. Cost to them and cost to the employees.

So, don't blame the insurance company. Blame whoever is providing you with the insurance.

Is there a reason why you didn't establish coverage before you went down this path? I read our coverage handbook and it said that bariatric surgery was NOT covered. I had the surgeons office double check and it would not be covered or any associated dr. visits. Because the coverage said explicitly that it would not be covered, there was no getting around it. Period. End of story.

[Sooverit! 1]

Hey Jena:

I think you hit the nail on the head as to why people have an issue with CIGNA As you stated :"Because the coverage said explicitly that it would not be covered, there was no getting around it. Period. End of story"

I called Cigna numerous times before I went down this path and they are very secretive and sort of sneaky and won't be firm in their decisions. They never told me what I was told in the denial letter because they know if folks out there know exactely what to do to get covered they will. They cover some people who are under a 40 BMI while not covering others who do have a 40 BMI. (for a year) They are certainly not consistent at least the Point of Service covereage!

[oscarel 0]

So far Cigna has been very upfront with me. When I called to inquire about bariatric surgery they emailed me their position on it, CIGNA HealthCare Coverage Position 0051. I also found this from cigna.com by searching for bariatric, it was the 3rd hit. And looking at the dates on this it's been in effect since 5/04. It also sounds like your surgeon's office should have some idea at to what Cigna requires, I would think they would have checked whether you were covered or not before you started. Now this is coming from my limited experience, I'm using a bariatric surgery clinic and I've only had to call them twice, initial call and one about them covering the psych exam. And as mentioned earlier your employer has a LOT of input on what's covered as they are the one's really paying for it.

[nursekathy2u 0]

Honestly, it's not the insurance company, it's the coverage that is selected. If you are covered by your or your spouse employer, it's really the fault (if it's anyones fault) of the employer. The company chooses the coverage, the co-pays etc. and it's based on cost. Cost to them and cost to the employees.

So, don't blame the insurance company. Blame whoever is providing you with the insurance.

Is there a reason why you didn't establish coverage before you went down this path? I read our coverage handbook and it said that bariatric surgery was NOT covered. I had the surgeons office double check and it would not be covered or any associated dr. visits. Because the coverage said explicitly that it would not be covered, there was no getting around it. Period. End of story.

Not always true.. sounds like she did not have an exclusion but was denied due to no co-morbidities that they accept. Sometimes it IS the insurance company... or in some cases the medical director.

I do this for a living... Since the first of the year I have had such a hard time with one particular medical director at Cigna. He is VERY PICKY and in my opinion will deny people on technicalities.. An example... He denied a patient because he said they needed "medical clearance" for surgery. He would not accept a note written on a prescription pad from the PCP that said " Pt is cleared for Bariatirc Surgery from a medical standpoint". I use these ALL THE TIME. It is common practice for doctors to write notes on prescription pads in leiu of dictating a formal letter when the message is short. This man is just being unreasonable. I have had several denials from him this year.. I never got denials from Cigna before. They were always very easy to deal with in the past. I don't know if he is new or what. But he is a pain. If there is a denial from Cigna it always has his name on it.

:redface:

[Sooverit! 1]

Thank you so much Kathy for understanding. It was my co mobidity issue - not that I don't have any...as many as anyone carrying 90 extra pounds and strong genetic predisposition for obesity related illnesses! I am currently in the process of an appeal. It seems like Cigna is saying no now but after a few appeals they cave in and issue an approval...I'm hoping?

[Carrie_C 9]

I think they will approve you if you keep appealing. Cigna denied me twice (and I have 3 comorbidities), but they finally approved it and I have a surgery date of 5/22. Keep fighting!!

[Sooverit! 1]

Hey Carrie C: Congrats one being covered and your surgery...I see you had a date of 5/22!! Hope all went well and you are feeling great!

All the best,

Marg

[Carrie_C 9]

Hi! I am doing great. The first few days were pretty rough, but I feel ok now. I am still on full liquids, but I can have soft food starting on Thursday. I go for my first fill on June 23. Have you appealed again? I heard from someone else on the boards that Cigna recently revised their coverage for surgery, I am not sure what they require now, but it might be worth taking a look at.

[Sooverit! 1]

Hey Carrie: Great to hear you are doing well! You are going to feel and look great this summer! Yeah and best part I think your body temp goes down so you won't feel the heat as much..that is if you are in a climate that the seasons change?> .(I can't stand the summer because I'm always so uncomfortable-any other time I'm fine) ! Sorry you had a rough time for the first few day though! Did you get pain meds I hope? You are so nice to ask about my appeal...I am still waiting to see if Walter at Obesity Law can save the day for me. Thanks for the heads up on Cigna also. Thurs will be here before you know it!

ALl the best to you!:laugh:!

[Carrie_C 9]

Hi! That's great that they are helping you. I was lucky because my surgeon's office handled most everything with the appeals. They seem to have it together and know the right words to use to get it approved. Is your surgeon's office helping at all?

Yes, I live in TN, so we have seasons. It is getting very hot now. I always hated summer because I always felt too fat to wear shorts and tank tops! Maybe that will change soon. I lost 8 pounds the first week! Good luck to you.