Cigna 6 month weight management - gain acceptable? - ThinnerTimes - Gastric Bypass Forum, Lap Band Forum, and Vertical Sleeve Gastrectomy Forum

Lark · 06-12-2009, 05:55 PM

So to my utter despair, Cigna rejected my claim today stating that I failed to complete the 6-month of physician-supervised weight management.

The person from pre-certification told me that the notes said that I had a gap between November '08 and February '09. I went November 22nd, December 31st then February 3rd.

This is my question - does Cigna require you have weight loss each visit? Because December was my only month of gain.

This could be insurance being insurance as I have been warned that Cigna claims they don't get items when they were sent to them.

Someone please offer some guidance as I am furiously upset tonight.

Thanks.

deputymauldin · 06-12-2009, 07:58 PM

Have you asked Cigna did the consider the appointments in Dec and Jan? I think that would be the first step. My doctor actually told me not to lose weight because the insurance company would say I can do it on my own. Good luck.

Ms. Readytobehealthy · 06-13-2009, 06:15 AM

Quote:

Originally Posted by Lark

So to my utter despair, Cigna rejected my claim today stating that I failed to complete the 6-month of physician-supervised weight management.

The person from pre-certification told me that the notes said that I had a gap between November '08 and February '09. I went November 22nd, December 31st then February 3rd.

This is my question - does Cigna require you have weight loss each visit? Because December was my only month of gain.

This could be insurance being insurance as I have been warned that Cigna claims they don't get items when they were sent to them.

Someone please offer some guidance as I am furiously upset tonight.

Thanks.

I would contact CIGNA back and advised that they take a look at those months again because there is no gap in months. Go back to your surgeon office and see what they sent in to see if they can locate any not of the sort. Something has to be a mistake here.

If they would have denied you because of the weight gain, then they would have told you that was the reason. I would call the surgeon office first thing Monday morning.

Sherry_Lynn · 06-13-2009, 07:31 AM

I know this is going to be hard to hear, but technically, you missed January. I know that you went early February, but Insurance Companies go by a strict calendar. I have Cigna too. My Surgeon advised me, as well as my PCP to do my best to lose during those 6 months to show I can take direction, and make an honest attempt. I did gain 2 pounds one month, and then lost it plus extra the next. You can try and fight them on this, but I think you'll be wasting your energy............just go on from February 3rd, Your last supervised visit should be around July 3rd. It will all be OK...........I know how hard the waiting can be. It was one of the most stressful times of my life. Good luck to you!

Sherry_Lynn · 06-13-2009, 07:33 AM

One really important point I forgot to add.............Call Cigna and request a Case Manager, will go a long way to making things a lot smoother for you, the Case Manager will make sure everything you submit gets to the right place, and will even go before the board to plea for you.

Lark · 06-14-2009, 01:25 AM

That actually eases my mind! If you had a month of gain and they accepted it then it can't be the gain.

I had other months where I wasn't on the exact date and even up to a week extra. Cigna clearly accepted that because they only said I had a gap from November to February. They are claiming they didn't get my December visit. And the time between my December and February visits was less than 35 days where they found acceptable being over that number of days between visits in other months (as evidenced by the only gap being listed as between those dates).

Cigna cannot expect you and your doctor to be available on the exact date of your last monthly visit.

But if they try to exclude me for not going in January under those terms I will gladly enter the ring with them.

So, fight me though they may, I will call the state benefits people and the insurance commissioner and then an attorney but they are not making me wait an extra month - I don't care if it's only one month.

Thanks for letting me know they don't reject for a gain because now I am armed to fight.

poet_kelly · 06-14-2009, 06:01 AM

Maybe your doctor didn't send them the December visit? You can ask him to send it again.

Kelly