Cigna 6 mo diet--help!! - ThinnerTimes

Jennaflirt · 05-09-2008, 11:09 AM

What are "significant gaps"? Please do tell. I have completed all labs, ekg, xrays, psych. eval, nutrition consult and 6 mo diet. I am missing 2 months. I also had an ultrasound on my heart. Due to the extreme hig blood pressure I now have an enlarged heart so my doctor included an ultrasound. now come to find out that Cigna requires 6mo consecutive with no gaps, allthough tha guidleins say no "significant gaps". So I now have to start all over again with another 6 months. I know it will go by fast but damn. I called the insurance company and they say there is no way around this. No letter nothing. Anyone have the same experience or any knowledge to share. I am afraid another 6 months could be damaging to my heart.

nikkibeat · 05-09-2008, 11:17 AM

Were there 2 consecutive months without any appointments with your dr, nut, or any labs or other tests documented? What about support group meetings? Is there anything related to your WL journey that can be submitted as documentation??

Amandazon247 · 05-09-2008, 11:26 AM

Ummmm you might call back ... cause I had a gap of like 7 months. I had 4 months of diet... then 7 month of cancer .. and then 2 months of diet and was approved. so they may just let you do 3 more month consecutively. I have GIGNA open access though.

Jennaflirt · 05-09-2008, 11:29 AM

I have 11/06,12/06,03/07,04/07. I was being monitored every 3 months due to my high bp. When I finally decided to do this the gb dr had all my diet info and so they told me to do my labs and such now I am told I do not have what is needed. I decided to do this when I discovered the enlarged heart. I have been on the fence for years. My cousin had the surgery and I said no way. But last year I spent 10 days in the hospital due to my bp and I am only 36. So I decided it was time to do what my doctor had been advising me. Get GBS. So here I am.

Amandazon247 · 05-09-2008, 11:42 AM

Ohh I see now... sorry girl but those dates are way off..... and you dont have 3 consecutive appointments.... I am sorry .... I had 4 consecutive and then 2 more later but all with in a year.... girl the 6 months will be over before you know it ...

Native2u · 05-09-2008, 12:19 PM

I have to agree with you Amanda. The dates are way off. If I were you, Jenna, I would start from scratch...and get 6 months worth of doctors appts. I would call your doctor and go ahead and make appts for a straight 6 months.

Jennaflirt · 05-09-2008, 12:24 PM

I have open access as well. That is what I am doing. I have April and May will 05/23. So I will be done in Sept. Just a bummer when you thought you were good to go. Thanks for the feedback. i will hang out here and suck up all the info I can from you guys.

Native2u · 05-09-2008, 02:08 PM

I was kinda hopeful too, when I first got my new insurance this year. But, the appts have to be.....back to back appts. It stinks, but, what are ya gonna do??

Baron Patrick · 05-10-2008, 11:38 AM

No way around this? Horse hocky! There is ALWAYS a way. If this six month requirement is going to threaten your health, then they can't require something that is going to be detramental to you. You can APPEAL the decision. It's a hassle, but must be done to build a "case".

I fought with these ba$tards for over two years and finally had to get the state involved. Check Nevada, they may have a similar agency. In California it's the Managed Care Agency. What they do is once you contact them and explain the situation, they then open a case, and request all medical records. An independent doctor has 30 days to review them and makes a final decision. Once a decision is made, it can not be appealed by anyone. Cigna claimed mine was not a medical necessity and the agency came back and said yes it is, and told them they had to provide me the surgery.

They want you to give up, so they don't have to pay for it. They will throw obstacles trying to get you to quit. Your fortunate in that they only ask for six months. Insurance companies are changing the rules and require 12 to 18 months. I've heard of one insurance company wanting 2 YEARS documentation.

Whatever you do, don't give up. You have plenty of documentation regarding your heart, and that must be taken into consideration.

Good luck, and keep us informed of what's happening!

Jennaflirt · 05-10-2008, 11:48 AM

I have made an appt with my dr and will advise him of the issue. Best case he comes up with the dates I need. And an additional letter advising of my health status. i am going to see what I can get him to do for me then go from there. He has said himself he is so happy my insurance covers it because he believes it to be the best thing for me. He is the one who talked me into it. I was opposed for a long time. But now I am scared. Thanks for the encouragement. I will keep on pushin and I will do whatever it takes.