XP: Is all hope lost for now?

I have Cigna, they have a requirement of six months of medically monitored weight loss before they will approve coverage for WLS.  I started going to the doctor in January and told her specifically what I was doing.  She said she had done it before for another patient.

I just got my medical records.  Basically they say that I was there for a follow up on obesity, what I weighed, what my vital stats were (weight, blood pressure, etc.).  Even though I discussed it, it did not mention my diet, exercise, etc, only that I was preparing to have surgery.  It mentions that I tried Meridia but could not tolerate it.

In June (month 5) I had to see another doctor because mine was unavailable.  That doctor simply wrote (f/u on obesity)

I'm thinking that there is no way Cigna is going to accept this and I have to start all over.  Anyone have any encouragement for me?

Is it unethical for the doctor to go back and amend the records if we actually did discuss those things?

I was on track to have the surgery in September.  I can start over with the six months this month, but that puts me in December.  There is no way I can swing the time away from work in January-April, which means it sets me back to May, almost an entire year.  We were hoping things would go well and we could start trying for a baby next Christmas.   I'm getting myself worked up over nothing right?????

Hey if all else fails with the insurance, go through your counties Vocational Rehibilitation Center. I fought insurances for months and still got denied. I heard about Voc. called them up set a appointment up and i am in the financial stage right now and they tell me it looks very promising that they are going to pay for my surgery. So try this if all else fails.

Don't worry, it will be fine.  I have Cigna as well and had much the same fears.  They don't need a tape recording of every word you and your dr discussed.  It's really a formality, I think, just to discourage you from getting the surgery.  What they are looking for is 6 consecutive months of official weight records.  It'll be ok as long as other criteria are met, like BMI and comorbidities.

Keep us posted.

OH Suzanne, I could kiss you.   I hope that's not too forward from someone you hardly know :-)

I think i've heard that Voc. Rehab. but I think it  is for people that are unable to work?  Fortunately, I can work and I don't have any co-morbid conditions.  I'm selling my mind anyway, so I could probably do that if I was double my weight, I just don't want to be.

Hi! 

I saw the notes about the 6 month weight loss documentation and need some guidance.   I spoke to someone and they were not very specific and pointed me to a website, which basically indicates I should have the doctor document the weight, type of diet and exercise program.    Is there any thing else?

Judy

I just got approved through CIGNA and while I dearly love my Primary Doctor I know that he can be a little ...overwhelmed at times. So I kept my own set of notes for the 6 months and at the end of my 6 months I gave him a copy of them and asked that he write a letter to my surgeon and the insurance company reviewing what we had done. That way the medical records were truly accurate - I was seen only for obesity checks and his letter would serve to fill in any gaps.

Good Luck to you. Once your file goes to insurance for approval call them and just be sugary sweet to check the stautus. Mine got routed to the wrong section and took an extra 3 weeks to get approval but I was approved nonetheless. If you go to the insurance forum and page back a few weeks you'll find a post by me titled "CIGNA" and the sole response is enlightening - Phone #'s and what have you.

pm me if I can be of help. Good Luck to you.

- Iris

Iris,

Can you either call me or can I call you?   Cigna wasn't very specific with what they want as to documentation.

Judy

Iris,
You are DA BOMB!  This will help a lot of people!

Thanks for sharing!

I think that it all depends on what your insurer wants when they are looking for the six month medically supervised weight loss attempt. As you may recall, my DH is dealing with an issue where the PCP did not document his medically supervised weight loss attempt appropriately and it won't pass 'muster.' I am still working on this for him and I recently received a post from another OH member that said she had a similar situation and her PCP was able to add an 'addendum' to each clinical record. The reason that they added the addendum is that they can not alter or 'amend' the existing record, but the addendum allows them to add additional information.

I would contact Cigna directly and ask them to please 'define' for you in detail what information they require for the medically supervised weight loss attempt. You can even let them know what you have and see if it will suffice. I'd do that instead of just 'guessing' to see if they'll accept it or not.

Wishing you all the best,

Barb