The Cigna Circus

I went to Dr. Blackstone's seminar on Sunday and was very impressed. Of course at the end, Cindy told us that Cigna requires two twenty-six week weight loss attempts with at least one of them in the last 12 months. I wasn't surprised because I had read that on the boards. Today I thought that I should get a hold of someone at Cigna and make sure that there are no more surprises that might trip me up down the road. The first woman that I talked to refused to give me any information and told me that only my PCP could give me that info. I told her that my PCP had said he doesn't know what the requirements are and told me to call Cigna, but she wasn't swayed. Well, if you want a better answer - ask a better question so I called again. This time I talked to a woman named Marty who was delightful. She read the requirements to me right out of the computer verbatim. 1. A BMI of greater than 40 for at least 5 years or a BMI of 35 to 40 with additional documentation of co-morbidity. 2. Must be of an acceptable age and health risk. 3. Three professionally supervised programs of 12 weeks with at least one of them completed in the last 12 months. A program qualifies if there is a regular weigh in at least once a month and the patient has been an active participant. There must be documentation of the program and participation. Qualifying programs include your physician, a dietician, community or self-help groups like Over Eaters Anonymous or Weigh****chers, an exersize program with a gym or a psychologist. You can try the same group more than once, but they have to be separate 12 week attempts. The medical director can waive one or more of the weight loss attempts if there are co-morbidities and especially if the patient has a life threatening illness. Overall the surgery must be medically necessary. So now, I'm not sure what to do with this information. I qualify if what the woman at Cigna told me is true. I have more work to do if what Cindy from Dr. Blackstone's office says is true. Any suggestions? Thanks, Connie

Connie, I'm impressed! I called Cigna four different times trying to find someone who would give me info. None would. Thank you so much for posting that. Keep us posted! Patti

Hello Connie, I just wanted to let you know that I am in the process of getting the Gastric Bypass surgery with Dr. Blackstone also. I am at the point where I am to get a Physc exam this Thursday Then see Dr. Blackstone on July 1st. The exam consists of two parts and as of Jan 2003 Cigna only seems to be paying for one of them. The nurse said there has been very few people who have been covered for both tests. The first one is your co pay and the other is costing around $200.00. Thank goodness I just received my tax return otherwise I could not afford it. I just wanted you to be aware since you are just starting out. Take Care Christina Garcia Any questions just email me at [email protected]

Patti and Christina, Thanks for the encouragement and info! Don't take anything I've learned as gospel because at this point, I'm treating all information from Cigna as suspect until I wake up in recovery. I just don't trust them. I've heard about the psych test and figured that I wouldn't get by cheap. I've heard from people who have taken it to just answer honestly and try not to guess at what they want to hear. I'll keep you posted as I learn more. Connie

Connie: I started this circus back in Nov. of 2002 and I still couldn't get that kind of info.I've already been denied once and they're saying that I don't met the critia with all my co-morbities.I've just now filed my appeal and got 3 of my Doctors to write letters to attest to the fact that the surgery would be greatly helpful to help cure all my problems. Stick to your guns and don't let Cigna have it's way.I'm fighting and they don't like to lose,well neither do I. I do have one 26 wks. weight loss attempt in my corner,but they want 2,but I've gotten letters written so try that route also.They have to sooner or later get the picture.Good Luck. Lizette Matus