sasha23

i have CIGNA insurance, and today i called and had them fax over their requirements for gastric bypass surgery. i have most of the criteria covered except the physician assisted weight loss that has lasted at least 6 months with no lapse in between. it asks for documentation once a month for those times.

is this what everyone is talking about when they say, they have to diet for 6 months first???

Godsblessedme

yep thats what we mean it'll go by fast you'll see

__________________

Deborah (before sugery)

Highest/Day of Sugery/CURRENT/Goal
268/262 /199 /130

Surgery Date: 12/18/07 Lap RNY
Onderland Reached 7/21/08

Gym Rat #98

Scale W #2

txchick1971

yes that's what that means......i have cigna too......just have to have your doctor provide blood pressure, and controlled weigh-ins for 6 months.......i wasn't even 'REQUIRED' to lose any, just maintain...i think i even gained like 5lbs......but they don't want you to gain any because it looks like you're trying........i couldn't really lose alot because then it would drop me below the required bmi........so, i just kept it steady for 6 months

__________________
~Tricia~



"It's all DOWNHILL from here baby!!!!"

~SmartAss Ghetto Booty Bear~

Started the process/info session: 6/5/07
End of 6 months supervised weight loss: 12/5/07
Insurance Approval: 12/5/07
Lap RNY Surgery date: December 28, 2007
Onederland 03/15/08

MYSPACE

LoriAnn925

Yes, that is exactly what everyone is talking about. I too had Cigna, and they will deny you if you don't have your documentation together. Your doc has to documents certain things on each of your monthly visits having to do with nutrition and exercise education. Along with your weigh ins, etc. If you search on Cigna's website, they pretty much tell you what they need.

__________________
LoriAnn 5'7.5"
Lap RNY: 9/25/06
307.9/154.6/145
Pre-Op(highest)/Current/Goal
Last Edited 4/28/08

Century Club - 3/31/07
Onederland - 4/30/07
Size 8: 12/15/07 -- I have reached Single Digit clothing sizes!!!!!
LESS THAN HALF OF MY STARTING WEIGHT!!!!! - 12/24/07

TT Gym Rat #20
"Destiny is no matter of chance. It is a matter of choice. It is not a thing to be waited for, it is a thing to be achieved." - William Jennings Bryan

Baron Patrick

Be VERY careful with CIGNA. I jumped through their hoops only for them to keep changing the rules. BE SURE to have a medical doctor monitor you as they WILL NOT accept weight watchers or anything else. Trust me, I fought with them for 2 years (and the long time peeps here can attest to that).

Even after you have satisfied their requirements, don't be surprised if they come back and deny you claiming it's not a "medical necessity." Which is what they did to me.

Your fortunate they are only asking for 6 months (which is what they asked of me as well). Insurance companies are changing their requirements to 1 or 2 years of medically monitored weight loss. I've even heard of one putting up a 3 year requirement.

I wish you the best of luck with them, and I hope you don't have the trouble I did with them!

__________________
Baron Patrick

It Ain't Over Till I Say It's Over-And I Won!
___________________________
Top / Pre / Current / My Goal
280 / 263 / 190 / 180


LAP RNY 5/29/07
TT Gym Rat Club Member #19

sasha23

to be specific it says: active participation within the last two years in one physician-directed weight management program for a minimum of six months without signficant gaps. the weight-management program must include monthly documentation of ALL of the following components: vital signs, including weight; current dietary program; physical activity (i.e. exercise program); behavorial interventions to reinforce healthy eating and exercise habits; consideration of pharacotheraphy with U.S. Food and Drug Administration (FDA)-approved weight-loss drugs, if appropriate. i am going to make an appointment to meet with my pcp next week.

LoriAnn925

I suggest taking their requirements to your PCP, so they can document the right things. It would suck to go thru your six months, just to have it denied because your PCP didn't document the right things.

__________________
LoriAnn 5'7.5"
Lap RNY: 9/25/06
307.9/154.6/145
Pre-Op(highest)/Current/Goal
Last Edited 4/28/08

Century Club - 3/31/07
Onederland - 4/30/07
Size 8: 12/15/07 -- I have reached Single Digit clothing sizes!!!!!
LESS THAN HALF OF MY STARTING WEIGHT!!!!! - 12/24/07

TT Gym Rat #20
"Destiny is no matter of chance. It is a matter of choice. It is not a thing to be waited for, it is a thing to be achieved." - William Jennings Bryan

wamble

I'm interested in this...which type of Cigna Insurance do you have? I have Open Access Plus and my PCP called Intercorp (who manages Cigna's WLS requirements, I guess), and it looks like I'm going to get stuck wtih TWO YEARS of medically supervised weight loss!!!

sasha23

i have POS open access. i work for the state but it has connecticut general life insurance on my card. these were the requirements that i had her fax to me. it's also online.

Amandazon247

Your weight loss clinic will give your PCP the correct form ... I have Cigna open access and had to do A 6mth diet.. but I had 4 or five month gap between the 4th visit and the 5th and they still approved me. They said as long as you had 3 months consecutively you were good. I was approved in about 72hours . So just do everythng they ask and you should be fine .

__________________
301/180
Before/goal
Surgery Date 3/31/2008
You can think of a million reasons to hate yourself today.... or you can be original and focus on one reason to love yourself. (manda2008)
N O T O R I O U S MANDABEAR!!