Denied until 6 months of PCP Diet?

I am fairly new to the site...and have been working the pathway to have surgery. I was so anticipating getting a surgery date soon. I found out this week that Cigna has denied me until I can submit documents that show detailed visits with my PCP that I have been under a supervised WL program. I am disappointed because although, I have been on numerous diets like everyone who is or who has considered WLS, I can't produce the documents that show a continuous 6 months.... Anyway I am just venting. But do wonder has anyone else got so close had this happen to them? If so what gotcha thru it?

I have CIGNA too and yes I had to do those lovely 6 months with my PCP. Right now it seems so unnecessary to you I know but you've got to do them if you want CIGNA to pay. Make sure you do them religiously - I went the first Monday night of every month when my PCP had walk in hours. I really didn't lose any weight but every visit was just for weight loss - no allergies, no in-grown toe nails nothing else but weight loss. We decided to follow a plan based on the South Beach diet. Every month we talked about South Beach. We set a goal for me to exercise 30 minutes a day. That took all 6 months to finally meet but we documented 20 minutes a day/ 3 times a week etc. He weighed me and noted my vitals and bmi at each visit. At the end of 6 months he felt very comfortable writing me a letter that said surgery was medically necessary in order for me to lose weight.

This may sound really strange but that 6 months was a blessing. It gave me time to break some bad habits and get preparred for my new life. During those 6 months I found this site and I gained so much  - information, insight & new friends. I felt more prepared for my surgery than I could ever have imagined.

Has your doc told you about not the 30 minute eating / no drinking rule. Basically nothing to drink 30 minutes before eating to 30 minutes after you've ate. It took me 6 months to break the habit. I'm the chick who would go to a restaurant and down about 10 glasses of tea or soda with a meal. Now I don;t even put a glass on the table during meal time.

Hang in there - just keep telling yourself that even with this set back that you're closer than you've ever been.

- Iris

Hi Jojo! I am having my surgery through CCS but with Dr Newman. If everything else is a go then go ahead and do whatever supervised diet the insurance wants. Just make sure to get the exact guidelines for the doctor so they can document it the way they want so that they will have to approve you. I went to my first seminar in Feb and finally had a date for Aug 4th but had to be rescheduled due to bronchitis. My Surgeon and my Doc did not want to take a chance of extra complications by operating on me when I was less than 100% healthy. I appreciate that they were looking out for my best interests and not worried about getting the fee that day. So you have started with a great clinic to have your surgery. Still having to have another delay is really frustrating. But you will get there.

I had to do it and my husband not only had to do it, but when our PCP didn't document it 'correctly' according to the insurance company, he's had to redo it. He has 3 of the necessary 6 done. Remember that with most insurers, it needs to be 6 consecutive months. My husband's and I believe most require that you have a dietary, behavior modification and exercise component to the program. For example, each month they discuss and the Dr. documents the dietary plan, exercise plan and what he's doing for behavior modification. Then the Dr. also documents the results of the plan during the past month. While they do want you to be making an honest effort, it isn't always necessary for you to be losing much or any weight, but they will want to know what you are doing and our insurance requires that the information is documented in the clinical notes. Not all require this, but you probably should find out from your ensurer exactly what they are looking for/requiring so that you don't end up in the boat my husband found himself in when they didn't accept the first 6 months documentation of his weight loss attempt.

Wishing you every success in your journey.

Barb

Thanks everyone for the tips and words of encouragement. Its nice to know that others had to do the same thing and to learn from their experiences.  I will consider this a blessing …and work on implementing the new eating techniques I must have in place after I am on the losing side. Ibeanniebe--- I had Dr Newman selected but could never get an appointment in this year (it seemed) so I switched to Dr. Earle (formerly Hardcastle) …Your date is just around the corner now….I hope all goes wonderful for you.

Hi JoJo!!

Nice to "meet" you!!  I'm afraid I have no words of wisdom for you on the 6 month diet deal, but I do wish you the very best.  I'm sure you will do great, and I agree that the time will probably go by much faster than you think. 

I'm still early pre-op myself (waiting on medical records) and I live in Reidsville.  I've decided to go with Dr. Fernandez at WFU/Baptist in Winston-Salem, but I've heard nothing but good things about your doctor and her group in Greensboro.  My PCP actually recommended Dr. Earle when he first mentioned weight-loss surgery to me.

Good luck on your "journey", and keep us posted!!

Warmest wishes
Cathy

Yes, that's a Cigna requirement -- and take it from someone who has been there (also with Cigna) that you MUST make sure that your PCP documents your visits correctly, or they'll deny you all over again! 

Each visit needs to be documented as a "weight loss visit" and you have to have a complete set of vital signs taken plus mention made in the note of the visit about progress you've made, what weight loss/gains you've made since the previous month, and what attempts you're making (exercise, pills, diet plan, etc.).  If you're missing the info, they'll flat out deny you and you'll be back at square one.  So make sure your PCP knows exactly how to document what you need in the notes. 

I had to do it, and what they're all saying is true.  I didn't have cigna, but you still must make sure that they're documenting it correctly.  Don't let them combine it with anything other than a "Weight loss visit".  If you have an ingrown toenail make sure it's a separate visit.  Seems wierd, but they're wayyyy picky.

Take care and good luck.
Ellen