Cigna: How often do the requirements change? (and other questions!)

[Dana36 0]

I am just beginning the lap band process, and called my insurance company, Cigna POS yesterday for some clarification on my requirements.

The website says that you need 24 months of medical history of obesity, the person on the phone said that it was 5 years of medical history that I would need.

So, can I assume that is changing? I do have 5 years, but for one year, one of the my weigh ins had a BMI of less than 40. I talked to him about that, and he said that if the other weigh ins were over 40, that it would be okay because it would still show a cycle of morbid obesity.

Also, I talked to him about the 6 month monitoring. My scenario is this: I went to the Dr in January, March, and April. Do I need to start my 6 month count in January (even though I missed Feb), or do I need to start it in March. He said to go ahead and start it for March. He said missing one month is not going to be held against me because of the long term obesity.

Does this sound right? Or was I just talking with someone that was leading me in the wrong direction??

Thanks!

[WorkingMom 0]

Hi,

You are on your way! I too have Cigna and was shocked to discover that I needed a 5 year history. It wasn't as hard as I thought, as I got records from various Dr.s from visits over the last 5 years = and all showed I was overweight.

As for the 6 consecutive months, I don't know. I would plan on needing to start with March, but submit in June/July and see. If denied, then start with the March appointments.

Good Luck! It seems like a headache, and it is, but...

IT IS WORTH IT!

[dawwhite 0]

I just went through the same thing with Cigna. You will need to start with March, otherwise they will deny your surgery. They try to make it as difficult as possible to make you give up! But don't it is definitely worth it!!! I'm so happy I stuck with it! Hang in there!!

[Dana36 0]

Okay, I will start with March.. that will put me at later in the fall before I get everything done. That will give me more time to schedule time off of work and stuff.

I already have the 5 years of weigh ins. All of them are over BMI 40 except for one, which I think was a 39.

I'm excited to actually get this ball rolling and be on my way!

[TXAmy07 0]

I just got approved with Cigna on April 1, and I agree that you should start with March.

But also - I did not have to do a 5 year history. They told me 2, and my surgeon sent in 3 just because that's what my PCP sent to them.

I guess it is better to err on the side of caution though. Just letting you know my experience.

[Bethanyblondie 0]

I also have Cigna. I basically "checkmarked" everything off the the requirement list (from the website) before I turned in my paperwork. I only submitted BMI proof from the last 24 months with my stuff and I was approved in a day and a half. So many complain about Cigna, but so far my experience has been fine. Granted, I worked my butt off for the last year jumping through Cigna's hoops in hopes that I would get approved on the first try, and it worked!

Sounds like you are on the right track though...and of course you have us all here to help you since most of us are experts on the requirements now! Good luck on everything!

[Dana36 0]

One more question.. on the 6 month diet monitoring, is there a certain amount we are required to lose? Neither of my dr's have mentioned it.

[Nchaka 0]

Where can you find the checklist on Cignas website? thanks

[Dana36 0]

Where can you find the checklist on Cignas website? thanks

I set up an account on their website, logged in and did a search for lap band surgery. The pdf with all of the information came up that way.

[ashleysara 0]

I am also wondering if there is a minimum amount to lose? I am on my forth month of the diet and I havent really lost but my doctor doesnt seems worried about me getting approved (cigna ppo bmi 43 and 19yrs old)

[dawwhite 0]

I did not have to lose a certain amount of weight before Cigna approved me. In fact, I think I only lost like 3-4 pounds in the 6 months.

[Bethanyblondie 0]

I only lost about 8 pounds over the six month diet...so I wouldn't worry about it! Now I'm just trying not to GAIN weight before my surgery because I don't have to do any pre-op diet and now I'm sort of in "last supper" mode! Two weeks to go!

[TXAmy07 0]

I was worried about losing TOO much, but apparently Cigna goes by the weight when you first began the process.

I gained 5 lbs in the beginning of my 6-months, and then ended up losing 40 lbs as of last week (probably 15 of that is from pre-op diet!), and my surgery is the day after tomorrow.

As far as having to LOSE for Cigna, it's not so much for them as it is for your surgeon. They put you on a pre-op diet that's low carb/low fat so that you lose some of the fat out of your liver, making the surgery easier to do, recovery faster, etc.

Your surgeon should cover that with you once you have a surgery date though.

Good luck!

[ShuileMom 0]

Is it two years or five years of medical history and do they just want to see what your weight was during those doctor's visits. I have to go around to five or six doctors to cover 5 years and if it is just for the past two years that would be easier. I only went to the doctor when I had to and then only to Patient First. I'm nervous this is not going to be been enough. How many weigh ins do they want to see. I've been obese for a long time but still fairly healthy. Doctors are not my thing. Your insight would be greatly appreciated.