Need Information on Cigna Insurance Approvals

Hi, My name is Ronald and I'm a new AMOS member. I have been overweight my entire life and have spent considerable time, recently, researching various WLS. I have Cigna insurance, which I understand can be problematic. I've had an HMO for 3 years, but the last enrollment changed it to and EPP, which is similar to HMO, but I don't need a PCP or referrals. What I was wondering if anyone could talk about are the necessities that have been observed for patients with Cigna insurance. I'm under the impression that 2 6-month Dr.-Supervised weight loss attempts must be met. I was under 18 months of care going through thyroid therapy in an attempt to make losing weight easier, which is documented. Can anyone provide information on what they know with regard to Cigna requirements. So far, I've not been able to get a list of requirements from them and verbal information on what's needed varies widely, depending on who I get in touch with at Cigna. Any help that can be offered would be appreciated immensely. I look forward to participating in this message board and look forward to getting to know all of you. Ron

Hi Ron, Welcome! I don't know anything about CIGNA, but there's a lady called Susan Burrows (find one of her postings down the list and go to her website) who has been trying to get approved with them for a while now. If you read her page you'll see her journey has been kind of frustrating, as it probably is with most insurance companies. Anyway, you can email Susan...she's pretty helpful and sounds like she knows a lot even though she hasn't had her surgery yet. Hope this helps, Paola

Paola, Thanks for responding. It does sound like Susan is the one. I'm looking forward to getting to know you through the message board as I go through the process. I'll talk to you again, soon. Ron

Ron, First of all, Welcome! Second of all, I am SO SORRY to hear you have Cigna EPP! I also have Cigna EPP, and have spent the last year trying to meet their requirements, and now have legal representation on my 2nd level appeal of the 1st level denial for an RNY. I should hear their decision by the end of this month. Anyway, there is a group on Yahoo that you should definately join. It is called "Cigna Squeaky Wheels" and it dedicated to Cigna plan holders that are fighting for WLS. It is a WEALTH of useful information. The link is: http://health.groups.yahoo.com/group/Cignassqueakywheels/ Also, I have now hired an attorney (he is also a member of the squeaky wheels group) who specializes in obesity law, and has had 100% success rate of having denials overturned. He is very reasonable in price, and is also a post-op RNY patient. Please feel free to click on my name on the message board and read my profile. It has a lot of cigna "stuff" on it. Good luck!!! Susan

Susan, I've just spent the last few hours reading about your particular journey with WLS. I must admit, I probably wouldn't have handled it as well as you have. I currently have an endocrine imbalance that makes the mood swings, well... Nasty!! When I'm mad, I'm mad for hours. On the up side; however, that puts my brain in gear and I wind up finding a way to stick it to whoever caused the anger. I suspect this journey will be much the same. I am deeply disappointed that my company provides Cigna insurance, especially given all the negatives I've heard with regard to Cigna. On the other hand, I have a friend who works with me at the same company who just submitted for approval in April and received approval in 2 days. I'm currently battling Cigna on approval of HGH, which is a medical necessity according to my doctor, but Cigna wants to hear that from an endocrinologist. Since they are so intent on hearing it from an endocrinologist, I will likely give them what they seek and have them pay for several "opinions" from several different endocrinologists. I have no problem beating Cigna over the head with what they ask for. I am looking forward to getting to know you through this message board and I do truly hope and pray that you will be approved, and soon. I'm just beginning the journey, but it's time yours comes to fruition. Hang in there an be tough and keep your spirits up. Will talk with you again soon.

Ron, Hi! Thanks for the message. Cigna seems to have approved several people on the first submission since the first of the year. However, most of them have BMI's over 50. Mine is "only" 44. I often wonder why I can't get approved when so many others can. My Mom and I think that maybe it is because I am not ever going to give up. Maybe some others would not have the fortitude to keep fighting if they were denied... so they are the oned who need to be approved on the 1st go-around. I don't know, but I am ready to go to the hospital TODAY! and I will be ready TOMORROW, and each day after that. I will not stop fighting for this surgery. Anyway, I look forward to getting to know you as well, and wish you all the luck in the world! Susan

Susan, I can appreciate the difficulty you've been experiencing in trying to get approved and all the emotion involved in dealing with denials and appeals but I take exception to your comment of: "Maybe some others would not have the fortitude to keep fighting if they were denied... so they are the ones who need to be approved on the 1st go-around" I would never assume to speak for anyone by making a judgment of what effort they may or may not have expended or be able to expend in getting approval. All I know is what I personally an going through. I spent 13 months pain-stakingly gathering documentation before my initial submission to Cigna and I was approved in two days. I feel very blessed that it came through so quickly and I pray daily for those having to fight beyond what I had to do. I won't call it luck and I won't apologize because some might feel my quick approval is somehow unfair. I'm sure it was just a matter of what was submitted and whose desk it went through. But I was just as committed to seeing it through as anyone who takes this surgery seriously. You seem like a very nice woman, willing to be supportive and helpful in every regard and I'm not trying to make enemies on this board but I would appreciate if you could just be aware of how your opinions might affect others. I see a lot of negative complaining on this and other boards and negativity feeds on itself. Every time I have a defeat or setback I try to step back and regroup and focus that energy in a positive way instead of making sure everyone I know is aware of the problem. Every single person who comes to this web site is having some kind of problem with obesity whether it's themselves or a loved one. We have all had many of the same obstacles and feelings about ourselves and how we have been treated by others because we are overweight. I hate to think this board would be one more place I would feel held to some unreasonable standard because my approval process wasn't as difficult or time consuming as someone else's. That's just my 2 cents, for what it's worth. And my BMI is not over 50. My surgery is one week away and I'm experiencing both excitement and anxiety. May the Lord bless all of us with the tools to live healthy lives and be with our loved ones as long as we can. Take care, Mindy in Littleton

Mindy, I certainly did not mean to make light of the the fact that were approved quickly with Cigna. I was only trying to make sence of why I have had to struggle with my approval. I am very thankful that each and every person who gets approved quickly is on their way to a healthy life! I would not expect you or anyone who has been blessed with a speedy approval to apologize for it. As far as you taking exception to what I said, and what you quoted back to me "Maybe some others...." I did not say anything even close to "Every single person who is approved 1st go-around". .. I did not in any way mean to imply that since you were approved quickly that you did not do your homework, or that you did not have the fortitude to fight. I do consider you lucky, as I do all of the people who have been approved for surgery, whether the approval was fast or slow. I will consider myself "lucky" someday as well. You know, as well as I, and as well as the others on this board, that there are individuals who might give up on this fight. All I was saying was that God gave me the will to fight for my approval. I look on my comments as positive, in the direction that they told people about MY struggle, and how I choose not to give up and to fight for this surgery - because I have been forced to fight for it. You and I differ on the way we view this board. When I post about my journey, I will tell it like it is - the good and the bad - the positive and the negative. I do not intend to offend you or anyone else. I have received much support and made many friends here based on the posts I choose to make - positive or negative. The only thing that I ask is that when reading my posts, please do not presume that I am directing any "negative" comments onto you or any other person. Susan

Paola, awwwwwwwwwwwwww thanks Susan

I'm no help with the insurance , but wanted to say WELCOME RON! Susan sounds like the one in the know! Susan, you are a gem!!