Denied by Cigna PLEASE HELP

[hallen651 8]

I was denied by Cigna OAP because I needed to prove that I had a BMI of 35 for 2 years and in 07 I only went to the doctors 1 time and my bmi was 34.7 so now i need to get a letter from my PCP and I need to write a letter myself to the ins for the appeal. So my question is does any one have a copy of a letter from your pcp or a letter you wrote to help with getting Ins to approve you for the surgery?

[Bethanyblondie 0]

I have a feeling you aren't getting any response because pretty much most of us know Cigna's requirements for approval inside and out, and proof of your BMI for 2 years is one of their big requirements. I don't really know what to tell you...if your BMI hasn't been high enough you probably will not get approved with Cigna. Do you have any co-morbidities? What is your BMI now?

[hallen651 8]

Thanks so much for getting back to me my BMI IS 36.8 and I have high blood pressure,gerd,edema,hyperlipidimia and i'm on meds for all.

[gamyj 0]

i have cigna, and they made me wait 6 months to lose weight with a plan ie.. my doc put me on a diet and i had to weigh in once a month for 6 months. I barely lost anything, and i too had co morbidities. they finally aproved me and i was banded on march 20th of this year. with cigna, u have to jump through their hoops, be persistent and you'll get approved. they are total pains in the butt! good luck, you'll be approved, just stick with nagging them!

amy

[pspmtnac 0]

I just got denied by Cigna for the same thing..it's a biggie with them, but i was able to get a record from the dr saying that in 2007 my bmi was over 40. Once they got that paper was approved within 24 hours!!!

[Bethanyblondie 0]

I got approved in a day and a half by Cigna, but I had literally "checkmarked" everything off their requirement list for approval. But they do absolutely require your proof of a high enough BMI from the last 24 months. I'm not sure what to tell you if you don't have the BMI requirement. Hopefully there might be someone on the forum that has had the same issue that found a loophole?

[hallen651 8]

I also did the 6 months and I only lost a few lbs to but with the 24 month paper work I only went to the doctors 1 time in 07 and at that visit my BMI was 34.7 so thats what denied me.So now I have a case manager with Cigna and they want my pcp to write a detailed letter stating why I need the surgery and to put in the letter all my co-morbid conditions and I also have to write a letter stating why I need the surgery so i'm so stressed that I wont get approved I just know that I wont give up.

[Snowball 0]

Is Cigna an insurance company on their own or a company based type or what?

[Bethanyblondie 0]

I'm sure if your PCP will write you a recommendation letter they'll approve you. Especially if you've had the co-morbidities the last two years. Sounds like you've got everything else covered.

[pspmtnac 0]

My PCP wrote a GREAT letter as well to send to cigna that went with the first packet of stuff and they still need to see that my BMI was over 40, 24 months ago..keep trying don't give up!! keep us posted!

[155forlife 0]

I ready my Cigna policy and it just says that your BMI has to be over 40 but it does not say for 2 years. What's that about?

[hallen651 8]

I was told that my bmi had to be over 35 for 2 years I was denied the first time around and I appealed and was approved I was banded June 15th and have lost 25lbs

[ParrotheadCathy 0]

Hey, 155. I suggest you find out what the appeal process is and work with your doctor to file an appeal. Part of it should probably include a copy of your insurance booklet that does not state the limitation. That falls in the range of false advertising almost, LOL. But, seriously, you often can succeed on appeal where you were denied initially.

[Bethanyblondie 0]

That may or may not work...I always used Cigna's website to check the requirements and it did state that you must have proof of your BMI for 24 months. Hope an appeal does work in your case though! Good luck!

[Bethanyblondie 0]

You know what...I just read through Cigna's requirements on line and it looks they were just updated on June 15th of this year and it seems they did remove the 24 month proof of BMI requirement! You might be in luck!