CAN ANYONE EXPLAIN WHAT CLINICALS MEAN?

I RCVD LETTER FROM CIGNA STATING THAT THEY RECVD MY REQUEST FOR GBS,HOWEVER IN ORDER FROM THEM TO DEEM MEDICAL NEC, THEY ARE REQ CLINICALS ? HAVE YOU EVER HAD TO DO THIS? THANKS FOR YOUR HELP ! :help:

Was it your request or a Doctors? Almost all Insurances require some proof that you have had a weight history of obesity, normally 5 years of doctors weight reports, you know almost all the time when you go to the doctor they normal weigh you even if it is for a sore throat, and/or proof showing your weight and attempted weightloss, like weigh****chers, Jenney craig, tops, South Beach. Sleep studies, showing if your weight is causing issues like sleep apneia, Cardiolgyst report, ultra sounds, and all kinds of good stuff.

Although I did not go through my insurance I paid cash for my surgery as a medical billing person yes I have heard of this. Basically they want medical documentation showing that you have previously been treated for conditions related to your obesity and documentation to show that you have tried other things in order to lose weight and keep it off. It would help if you can get your PCP and any other health care provider that you have seen in the past to write letters of medical necessity. I had letter from my PCP, cardiologist, endocrinologist as well as several others but because my benefit for WLS is so bad I decided to pay for it myself. Good luck and let me know if I can help in any way I may have some tricks of the trade if needed. BArbara

I too have Cigna/ their requirements are for 6 mos dietary records, sleep studies, lab work and statements from PCP and Bariatric Surgeon for certification of need AND psychologist and nutritionist statements. Their criteria is BMI of 40 for at least 1 year OR 35 with certain comorbidities such as Diabetes/fatty liver/ hypertension, your doctor's office should have also received the same letter from Cigna. Remember that MD has laws that state the insurance company CANNOT request more information for consideration than what is in your policy. You can call Cigna (I did) and ask that they send you the list of your policy's criteria for WLS. Good Luck