cigna pos bmi requirements for surgery

[tamarabennett 0]

i just received my 2nd denial letter from cigna stating i had not shown a bmi of 40 or 35 w/1 co morb for 24 months, during my 6 months of physican supervised weight loss last year one month my bmi went down to 33.8 , i am type 2 diabetic so i should fit in the 35 bmi with one co morb catagory, I can not find in cigna guidelines if my bmi for 24 months was prior to physician weight loss or if is from now, does anyone know? can you drop below the 35 bmi during your physician weight loss or do i now have to wait until ive been over the 35 bmi for 24 months and redo my physician weight loss and not go under 35

[CMTurner 0]

Here is a link to Cigna's coverage position on bariatric surgery. I would suggest you call Cigna and see if there is something they are missing in the notes being sent by your physician also. Good luck.

http://www.cigna.com/customer_care/healthcare_professional/coverage_positions/medical/mm_0051_coveragepositioncriteria_bariatric_surgery.pdf

[angelbabybrandi 0]

The only way you will have a chance of getting it approved at this point is to do another six month diet where your bmi remains above 35 and send them the new diet along with a weight from 2006 and 2007 showing your bmi above 35 and also your records showing your diabetes and treatment.

It is best to send the appeal letter to the appeals department on the cigna letter and send it with a statement saying what they denied you for and how you are proving they are incorrect... such as ... I am writing to appeal the decision for lap band surgery... in your denial you stated that I did not meet the following guidelines..... I am enclosing records showing my bmi of ... for the past 24 months along with my medically supervised diet and any thing else they said you needed.

Just remember that with Cigna your nutritional, psychological, recommendation letter, and surgeon evaluation are only good for 12 months so if any of these are older than that when you get ready to resubmit you will need to do them over again.

Good Luck

Edited October 18, 2008 by angelbabybrandi
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