Cigna's Hoops

[Bethanyblondie 0]

Well...I've done it! I'm finished with my six months of supervised weight loss (lost like, a whole 8 pounds..woohoo). I worked my booty off this year gathering up all the information I thought Cigna needs to approve my surgery. As far as I know, I've "checkmarked" their list off and I've got/done everything they require. I have no co-morbidities, but my BMI is over 40, so I'm not really worried about that.

My question is, I just called the lady at my surgeon's office who submits the insurance stuff, and all she wants from me are my six weight checks from the doctor and my psych evaluation. I spent $50 to get my medical records from Kaiser so I'd have proof of my weight from two years ago, and she didn't even ask for that. I know she's done this a million times...I just found it odd that Cigna's website shows ALL these things you have to have and she only asked for a couple of them.

Have any of you recently been approved through Cigna? What kind of experience did you have? Do I just need to have that other stuff around "in case" they ask for it? Any responses would be appreciated!:welldoneclap:

[GoneFishin 0]

Cigna is not my insurer and I am not familiar with their requirements but, having dealt with BCBS, I suggest that you INSIST that your surgeon comply with all Cigna's requirements and submit all the information initially. My experience is that your insurer will not approve your surgery without it. Delay will only cost you precious time down the road.

[hollisterblondie 0]

HI! I went through the same thing with Cigna. It took me almost a year from start to finish with them to get an approval. I got the run-around from them saying they didn't receive all of my paper work, they couldn't read the faxes, I had not completed all the nescessary steps for an approval....you name it they tried it.

When I went for my first meeting about the Lapband I received a 3 ring-binder full of information from what I needed to do... to what to do if you are denied. They had an attorney in California that helped with obseity surgery denials, and suggested going with them. The attorney that helped me was Walter Lindstrom at Obestiy Law. It was funny, once they took my case Cigna heard the name Walter Lindstrom, and Obesity Law... it didn't take but a phone call and I was approved. :welldoneclap: So you might throw in their name and Cigna might give in a little eaiser.

Good Luck to you! Don't give up, as that is why they are making you jump all the hoops, thinking that you will give in and give up! It is very well worth fighting for!

[lindas0809 0]

Hi! This is weird because I just went through this with aetna they make a big deal about a two year weight history on their requirement list and my office coordinator told me to get it also. Anyway, I finally got my last stuff done and was going to send in my weight history, but the office had already submitted my paperwork without it. I had the case number and was going to fax it in myself because I was so worried, but Aetna approved it before I could. I would suggest getting to the office(and keep a copy for yourself)- I would rather have them turn in extra documentation then to have to go back and have an appeal.

Good Luck !!

[TXAmy07 0]

I just got approval from Cigna this past week and for approval with them I needed: psych eval, nutrition eval, 6 months supervised diet, 2 year weight history from my primary doctor WITH a note in my charts stating that she had recommended me for LB surgery. (I was told by my coordinator that you can actually get that from your 6 month diet doctor if need-be but it has to be a separate visit with a note stating you should have LB - she said that's a new one that Cigna has suddenly started denying folks for not having)

It was 32 pages of info, and it was approved 8 days after Cigna got the packet.

I would FOR SURE ask the person at your doctor's office again. If she keeps insisting that you don't need all of that, I'd call Cigna and ask them. Maybe even call twice just to ask two different people. I am sure she does it every day too, but maybe she's mistaken on this one, or who knows. I don't know if they differ per policy but I'm just giving you my recent experience.

Also, another hint that I found is to call Cigna and ask if your paperwork is in the "nurse's queue" - some of their phone people can actually access the approval department's queue to see if your stuff is in there to be looked at yet. (When they first get your paperwork it basically sits in an inbox until someone goes in and actually puts your stuff in line to be looked at) I think that helped speed mine up a lot.

I hope this helps, and good luck to you! :welldoneclap:

[gamyj 0]

cigna was a nightmare for me... they too kept giving me and the surgens office the run around... my surgens office sent the same info to them at least half a dozen times.. the kept "not receiving" things ... finally i called and talked to a manager, and basically called every few days until i got approved. it was the biggest pain in the ass ever!!!! good luck with everything and stay on top of cigna!!!

[Bethanyblondie 0]

Thanks everyone, for all of your help/advice. I had been told that Cigna is basically the hardest insurance to get approved through. But my two choices of insurance through work were Cigna or Kaiser...and I knew Kaiser would be worse!

I am going to put ALL the documentation I know is required by Cigna into what I submit to the insurance coordinator...and I will INSIST she send it all in. I hadn't heard about Cigna needing a recommendation letter from your PCP for approval...back in January when I talked to the coordinator she said that Cigna didn't want letters like that. Don't you love how you get a thousand different stories?

Oh well...I was prepared to battle for this if need be...let the battle begin! BRING it Cigna!

[kaparamo 0]

I have Cigna as well. I have the consultation with my surgeon on this Wednesday and then the coordinator will submit my paperwork for approval. My boss and I have been going through the process together and although I started before her she already had the 6 month diet previous to the lap band journey. Her paperwork was submitted and denied due to not having a letter from her primary care DR. She went right away to his office and got one and was approved within a few days. When I learned of this I requested the letter from my DR and he sent it within a day. The coordinator at the surgeons office had also said that sometimes Cigna was coming back and asking for a 2 year weight history so she called my DR and asked for that. It seems all my ducks are in a row now. By the way...my boss just had her surgery on Friday and with all the bumps in the road for the approval it still only took like 3 weeks for her to get approved. Good luck...I know how the waiting game is...NOT FUN!!

[TXAmy07 0]

Kapamaro - that's pretty sweet that you are going through this with your boss. I wish I had someone that I was going through the process with like that.

Back to the Cigna thing, I don't think the letter or note from the PCP was even on the list that I got from Cigna when I first looked into LB. When I got almost to the end of my 6-month diet I called the coodinator and went over what all I needed, and she said that Cigna had just started denying some because they were not recommended for LB by a doctor. She said if my charts from my PCP showed that she had recommended it in my 2-year history that would work, but if not I needed to make an extra appointment with the doctor I did my 6-month diet through. Luckily my PCP did mention it in her notes since she was the one who recommended it, so I was ok there.

I do love all the different stories - it just seems like it depends on who reviews your stuff as to if they allow it or whatever. But I'd rather have more than enough info to convince them than the opposite! Keep up the good fight! You can do it!!!! :smile2:

[kaparamo 0]

TXAmy, It is pretty awesome that my boss and I have each other to lean on. We are only an office of 3 now and we are all 3 really close. I may have mentioned that I started the LP journey before her but she got ahead of me because she did not need to complete the 6 month diet. I had a few road blocks due to some blood test be goofy with low sugars but it turned out to be fine.

What you were saying about it just depends on who gets your file to review...that's it exactly. My coordinator said that as well. She said sometimes she needs extra things and sometimes not so she has just been including it all to not have any problems.

I went to visit my boss yesterday and she is doing fabulous. She was not in any pain and had stopped taking the pain meds the day before. She did say her left shoulder hurt a lot...I guess that is where the gas (that they pump you up with) settles. I can't wait for my turn. Be sure to drop a line when you get approved. We may be May Bandsters together!!! Good luck!! Kristie

[Bethanyblondie 0]

I called and left my doc a message today about getting a recommendation letter just to be safe. I wonder...when I originally went to her in May 2008 for a physical and to ask about the lapband, she DID refer me to a surgeon to talk to...does that mean she "recommends" me for surgery since she gave me a referral? Hmmmm....

[TXAmy07 0]

Bethany,

If your doctor put that in your charts, and that will be part of your 2-year history I bet you will be fine! That's all mine had as well.

Good luck!!

[kaparamo 0]

Bethany, I had mentioned to my DR that I wanted the LB and when I requested a letter he had no problem writing me a really great one reccommending the surgery. I am sure whatever letter you can get or even the mention of the LB in your charts will be fine like Amy said.

I go to the surgeon consultation tomorrow and then my paperwork will submitted to the insurance for approval. I hope it does not take long. Wish me luck!!!

[TXAmy07 0]

Good luck Kristie! Keep us informed. Hopefully we can all 3 be May-dates together!! :thumbdown:

Amy

[Bethanyblondie 0]

Man...if I could get banded in May I would be SOOO happy! I did NOT hear back from the medical records lady at my doctor's office...as I feared...and she is out on Wednesdays. But guaranteed Thursday morning I will be going to the office and hunting her down in person! I just need my freakin' weight checks! How hard is that!!!???