Unicare HMO / CIGNA PPO

Has anyone had either one of these companies?  Approvals /denials any suggestions. Thanks much.  Diet supervision; CIGNA says weekly doctor supervision. Does this mean documentation, or actually seeing your "doctor" each week? Thank you,

I think that I have heard it all - "weekly doctor supervision". That seems a bit much. I have heard of monthly for anywhere from 3-18 months for many different insurance companies. Weekly would be very costly and I do not think that they would pay for an office visit on a weekly basis, monthly yes but not weekly. Documentation is of the upmost necessity. The more a doctor charts about a visit the better. S/he will need to make sure that there are comments there about your weight, what you are doing on your diet, exercise if you can do that, etc.  My husband had Cigna and they just wanted 6 months of a supervised diet but not weekly. What I highly recommend is that you get the requirements verbally from a rep and also in writing from your insurance program book. All insurance companies distribute the written policy. If you cannot find it they have to provide you with an additional copy.  Christine

Dear Christine, your husband had CIGNA? Did he have the surgery, can you share his approval time or challenges? Thanks

He needed to have his surgery as fast as he could and he first was approved for surgery (with Cigna) then they denied him because he did not have the 6 months of monthy supervision. He had his surgery with my ins, BCBS of IL. He might have been approved with the notes from his chart from his doctor but this doctor was not in the Cigna plan. He had been trying to loose weight for years and his doctor's notes would have proved it, but like I said he needed his surgery sooner rather than later. His bmi was over 55 and he was told he would not see 60. he just hit 60 last August 1st and is going strong.  I have a very encompassing policy and we both were approved with out monthly diet supervision. Of course it could have been at that time we did not need the 6+ months of supervision but we both were determined to be under the umbrella of our surgeries were needed because it was medically necessary.  Like Connie said they are tough to deal with. I have read some answers to the Cigna question on this forum in other areas that say that they are hard to deal with and then sometimes I see some people that are approved real fast. Try the Ins forum here on OH and see if you can get any answers. Christine

I have Cigna through the state of IL and I thought they were a pain. It was six months of supervised weight loss by a physician and don't skip a month or you'll have to start over. My PCP had me come in on her day off to get weighed in order to work around her vacation and mine. There is a list of things which have to be in each case note in order to be accepted and Cigna will send them to you. I took them in with me each time and asked her to write on each one which she did in front of me. I was still denied twice but eventually they did accept me and paid well, actually. I went to Madison to a Center of Excellence and Cigna approved the Meriter hospital which turned out to be the finest hospital I have ever experienced! So even though the whole process took 11 months it was well worth it. Do exactly what they tell you!

Connie 

Thank you very much. I work for the state also.  Here's my question, is it monthly supervised by a physician?  Is there anything else.  How has the Lap Band been for you?

It is monthly with a physician. I used my primary care provider. They wanted the case notes rather than a letter. My program usually doesn't do the nutritionist and psych eval before insurance acceptance but they made an exception for me because Cigna wanted that stuff before acceptance.

I have  lost 75 lbs in 5 months and I love my band. I would do it again in a minute!

Connie 

Thanks to all of you - I will keep you posted. I have started my diet plan with my doctor. I am searching for a doctor in illinois. I have seen 2, i'm going to visit with one more and get started. I only have a choice between Unicare and CIGNA.  Unicare has like this discouraging 3 year plan. So I ned to make cigna work.  God Bless, kc

I used Cigna PPO for my insurance.  I had to do the 6 month supervised diet.  And that was it.  And approved it with no problems w/approval in about 2wks.  But as of 2008 my husband's employer is no longer covering Gastric Weightloss Surgery.  So I made it under the wire.  Good Luck!