Okay Cigna people ... Questions!

Yesterday I found that our group policy through Cigna does NOT have an explicit and specific exclusion for WLS. Which is a good thing. But as I'd be researching this from the self-pay point of view I'm not sure what's next to do. I know that I haven't got 6 months of physician supervised and documented diet effort. So toward that end I have already made an appointment with my PCP for 1/3 for a full physical, bloodwork, pelvic exam and to discuss and start a supervised diet. I'll also talk to her about WLS and give her information on some hypertensive episodes I've recently had and some joint pain issues that I've not mentioned to anyone because I figured they're just part and parcel of being fat. I've also printed out and will be taking a 20 page Coverage Position paper for the doctor so she can see what the supervised diet must consist of. I have an appointment to attend a lap-band seminar with a local surgeon tomorrow and will spend time checking out other surgeons so I have an idea of who I would be comfortable working with. Is there anything else I can or should be doing? Thanks, Carole

im a cigna girl and first let me say i hate them and be prepared to fight... took me 3 denials to finally get an approval... ok... about the diet... my hospital had a program where you could go weigh in and their was a lecture thing... get a letter of medical nessicity (SP?) and your surgents office will tell you all the mambo jambo you need to get threw alexa

Feel free to borrow the PCP letter I have on my profile that you can tailor to your own situation and take to your PCP as well. Also be sure your doctor understands that office notes are required and not JUST the letter. I've also been told that the monthly visits have to be pretty darn close to being exactly each month and not at 3 week intervals or 6 weeks either! Fussy insurance companies!! Jan

Thank you both so much. I'll be honest - I want to do things as right as I can because I'm not doing more than one appeal. I've heard that Cigna tends to deny approval after the first submission and approve more on appeal (I'm sure they do this hoping people will give up or go self-pay). Since I am in a position to self-pay without major stresses I don't plan to do more than one appeal. But I'll give it a shot first. Once I talk to my doctor about the medically supervised weight loss program I plan to sit down with her appointment person and schedule all 6 months of appointments in advance. I'll try to keep them as close to monthly as possible. I figure scheduling in advance might help with that. Though how Cigna can reasonable expect that is beyond me, appointment scheduling is certainly not a science. Ugh. I can already feel my blood pressure rising and I'm haven't even started the whole dumb process yet. Thanks for the letter, Jan. I will definitely take that with me. I'm also planning on making two monthly fill-in tables. One for dietary compliance and one for exercise compliance. I'll fill those out for the month and sign them, ask my doc to sign them and keep them in my chart to go to Cigna with her letter and her notes on my compliance. One more level of "proof" for them. Thanks again for your help.

I didnt want the fuss from Cigna (International - which is a tad different), so I was a self-pay. But Cigna is picking up all of my lab work bills and any other tests I had to do before and after WLS.

I went to a seminar with the surgical group that I want to use and their office manager/bariatric coordinator was pretty honest and upfront about the problems they've had with Cigna. Everything she said mirrored the things I've been hearing about online. My mom - who was at the seminar with me - has urged me to skip the insurance hassle and just go self-pay by taking out a loan from the National Savings and Loan of Mom and Dad. I think that is what I am going to do. I'll be honest I don't want to fight this. It took me years to get to a point where I wasn't terrified to admit that I need this and months to get to a point where I could admit to anyone that I wanted to do it. If I have to fight my insurance company I just don't know that I'll go through with it. Does that make any sense?