Anyone ever re submit a request a year later to Cigna

[Sooverit! 1]

I was wondering if anyone was denied by their insurance co...my case CIGNA and resubmitted the claim a year later. I was only a 38 bmi when I submitted in March now I am a 40 and thinking of starting the whole bloody process all over again. Would really get depressed though if I went thu that again and was denied again. Was wondering if Cigna would go for that...if anyone has anything to offer it would greatly be appreceiated.

Going thru a 2nd appeal process now...with kELLY and walter at Obesitylaw.com in the meantime this summer with all this excess weight is really taking it's tole on my soul.

SOOVERIT!!!

[HeatherO 7]

I don't think you would be able to resubmit the entire claim but I think some parts of your original claim would still be valid (such as 6-month doctor supervised weight loss plan) if you had to do that. You will probably have to redo some tests. Just speak with them and ask about the timeframe in which the tests must be taken prior to surgery. It should be a fairly black & white question for them.

Now that your BMI is 40, you have a much greater chance of success.

[cathychatts 1]

Looks to me like Cigna would approve your surgery at 40bmi. That is their requiement! Good luck, I know you have really worked on this! I have seen some of your other post. I have Cigna and they approved me right away with one appeal, of course I had a BMI of 40 and several co morbidities.

Best of luck to you!

[Sooverit! 1]

Hi Cathy:

Thanks for responding and I just love your quote.. ..and so simple!~ but so true!:-) Mine is "Life isn't about what happens to you but how you choose to respond (or not) when it happens". Back pats to you for your great weight loss so far....you must feel great. I haven't lost that much weight in a decade but I know how great it feels to be in that direction!

Hi Heather and thanks for responding. I'm thinking of going to Mexico...never thought I would but reconsidering now that there are so many fill docs around. Cigna is tricky they want me at a 40 bmi for at least a year and the 6 mo diet within a year...so.I would have to do the 6 mo diet over.

[Sooverit! 1]

woops Just looked on Cigna's main website and it's all very clear what they cover now. There is a big change tho...they require 24 month of a 40 BMI now....not 12 months..

[mlzzlfshzzl 0]

Looks to me like Cigna would approve your surgery at 40bmi. That is their requiement! Good luck, I know you have really worked on this! I have seen some of your other post. I have Cigna and they approved me right away with one appeal, of course I had a BMI of 40 and several co morbidities.

Best of luck to you!

Hi, I'm new to this site and I was just reading your post. I have Cigna HMO and have not even made it to the submission or approval part yet. I'm scared Cigna won't cover it. Do you mind me asking what kind of Cigna you have and the details of what you had to do to get them to approve it?

Thanks in advance for your help!!!!!:cool2:

[mlzzlfshzzl 0]

Looks to me like Cigna would approve your surgery at 40bmi. That is their requiement! Good luck, I know you have really worked on this! I have seen some of your other post. I have Cigna and they approved me right away with one appeal, of course I had a BMI of 40 and several co morbidities.

Best of luck to you!

Hi, I'm new to this site and I was just reading your post. I have Cigna HMO and have not even made it to the submission or approval part yet. I'm scared Cigna won't cover it. Do you mind me asking what kind of Cigna you have and the details of what you had to do to get them to approve it?

Thanks in advance for your help!!!!!:cool2:

[cathychatts 1]

I have Cigna Open Access through the state of Tennessee.

In order to qualify I had to show a BMI of 40 or over 35 with co-morbids. I could show the yo-yo for over 5 years with the BMI over 35. I made sure that I had a BMI 40 when I went for the 1st weigh in, but I did not have a history of BMI 40, I did over 35.

Then I had to show 6 months consecutive weight loss programs. I had months with a doctor program that had the dietician and a Physical Therapist. The other month was a weight loss clinic that gives Phentremine.

I sent records that showed sleep apnea. I also have asthma and bad knees but I didn't show that.

The first request was denied, then we faxed the records again showing only exactly the records that showed the 6 consecutive months and a letter I had written stating why I needed the surgery for my health.

That was approved right away.

I hope this information helps! Good luck!

[Sooverit! 1]

I have open access through NY...I went on the CIGNA web site yesterday and noticed they changed their requirement to having a 40 BMI for 12 months to 24 months. Unless I read it wrong, this is a big change. I found the new requirement page on Cigna.com under bariatric sugery. I recently heard they also look for a 10% weight loss during the 6 month physician supervised diet.

[cathychatts 1]

Are you working with a surgeon? They did most of the work for me. I did not have a constant BMI of 40 over the past 2 years, acutally I had lost and gained about 70 lbs over a 3 year period. I think that may have been the thing that sealed the deal.

do you have any co morbidities? That is also important! If your bmi has ever been high in the past and you gained the weight back. Look back over your records. I actually paid to have all my records copied so I could look back about 10 years.

[tamarabennett 0]

Are you working with a surgeon? They did most of the work for me. I did not have a constant BMI of 40 over the past 2 years, acutally I had lost and gained about 70 lbs over a 3 year period. I think that may have been the thing that sealed the deal.

do you have any co morbidities? That is also important! If your bmi has ever been high in the past and you gained the weight back. Look back over your records. I actually paid to have all my records copied so I could look back about 10 years.

I am type 2 diabetic and trying to get approved with cigna and last year during my supervised weight loss I went below my 35 bmi twice due to I lost 70 lbs and i put it back on the minute I stopped the weight loss supervision and phentermine, how did you get cigna to approve you with you going under your 40 bmi? that is the problem i having right now im on my 2nd denial

[Sooverit! 1]

Hey Tama:

The fact that you have Type II diabetes should definitely get you covered by Cigna. They are notorious for holding back on covering lap band candidates, but they can't deny you as this is a "co-mobidity" that regardless of your BMI being under 40 (as long as it's over 35) they state they cover. Have you looked on Cignasqueakywheels.com yet?

Don't give up!

[tamarabennett 0]

the problem is the low bmi was within the last 24 months it was a bmi of 32.8, it was during my 6 months of weight loss, right now cigna is not even putting me in the 35 bmi catagory i dont know why they are not identifying my type 2 diabetes, and severe sleep apnea as comorbids and i have a hx of uncontrollable hypertension and current reading of hypertension this past august but im not sure if they will except that as a 3rd co morbidity. So right now im trying to get them to at least show me in the 35 bmi range and then fight my case from there that the low bmi was during my supervised weight loss and my average of bmi over the 24 month period was well above 35, my other problem is my supervised weight loss , my past pcp did not document everytime i saw him 9 months for it and i have 6 documentations out of the 9 times but there is one gap of 4 months so i am sure they will call that a significant gap, i went and saw an dr and talked to her about starting my supervised weight loss again and she wanted me to go to a dietician to document diet and exercise and i fear since its the dietician documenting and not the doctor that wont work either for in the future, and my 6 months of redoing weight loss would end after my 180 appeal days if they mean 180 calendar days , but when you so i dont know what to do, im trying to figure out right now when they say you have 180 days to appeal is it 180 calendar or business days, because when you call and ask how long it takes them to review things they say its 30 business days, and if i get a final denial im trying to find out how long until i can resubmit a new case

[Sooverit! 1]

I feel your pain Tamara I"ve been beaten down by CIGNA also. What i've heard in this past year is not to give up. They have changed the criteria on their web site that you have to have a 40 BMI for the past two years now...used to be 12months. They drive the people at obesitylaw crazy too.

The positive side to this all is that it is getting cheeper and easier to get the band out of pocket. My surgeon now offers an out patient procedure which is $17,000 with fills for two years = this is in NYC .tho. ..Ihave to check that today tho may only be one year. But at any rate it is $7,000 less to get the surgery in Mexico (Dr. Rumbaurt) which I'm sure is safe and good care but still flying to MX and being on a plane all that just doesn't seem the healthiest choice. I'm not as young as I used to be turning 50 next year and don't feel as invincible as I once was. PLus it takes time you stay overnight and 2 days in the hotel plus travel time. I think I have to think of it this way: If I knew that $17,000 could safe and extend my life plus give me more energy and be more marketable regardless of what it was ....would I come up with the money for it? Somehow we would. I have to get it out of my head that this is a cosmetic proceedure ....every day I am truly believe it is a health issue. I like to exercise, walk, jog, and yoga but lately my joints and muscles and feet are always in pain. I no longer have to convince a insurance company I have to convince my self that I am worth $17,000!

thanks for letting me ramble. I need to get this clear in my mind too.

You've got the space here if you want to just think it through in your head too. We are lucky we have this great (safe) very well behaved site. It truly is a miracle like the Lap band. Any other BB is filled with rife. You never know what can happen my primary care doctor just started studying to be a Fill Doc and told me many of her patients get reimbursed by their insurance companies after they pay out of pocket and give up on them paying...who knows. You'll find an answer if this is meant to be.

best to you,

m