Help! Insurance Question

HI! I am new here and I need to ask a question to those who know a lot more than I do. I have Cigna POS Open Access. I am almost finished with my 6 month weigh-ins. My PCP was not really helpful, she gave me no program to follow. I have only gained weight. I haven't been able to exercise because of lots of pain and inflammation in my body. Not sure if it's arthritis or fibromyalgia. I have an appt with a rheumatologist. I have been eating so much less food and I think moving more, I just adopted a daughter she is 21 months old. My hypothyroidism has been getting worse so I am just now taking meds for that. With all that said: will I be denied because I didn't lose any weight? I am feeling so hopeless right now. If I could lose weight on my own, I wouldn't need this surgery. I would appreciate your input! Thanks a bunch, Cindy G

I would think they would be more inclined to deny you if you did lose weight. Then they could say you don't need surgery. Best of luck to you! Never give up, fight with all your being! It's worth it, trust me!

Hi Cindy and welcome to the TN board. You realize that with an underactive thyroid you will have to take the medication for life. If you're PCP is not backing you 100% then you need to change Dr.'s. You will need a letter of referral from your PCP stating that it's medically necessary that you have this surgery. If he/she is not willing to do that, get you another one asap. As they will also be in charge of your recovery. Cigna will approve of your surgery as long as you have met the guidelines. I wish I could help you out more, but I only know that another had the same kind and she was approved. May God travel with you on this journey, Kathy

Hi Cindy! Welcome to the TN boards! I am sorry to hear about the problems you are going through. I have Cigna HMO. It really does depend on your insurance plan. I have known plans to say that you have to lose 10% of your body weight or something like that. If that is the case, it will be written into your plan. My plan did not say a restriction that I could see. It just said I had to be on the program for 6 months. As long as your Dr writes the letter for you and states you completed the six month plan to the best of your ability, then you should be fine. I did not lose much weight. I only lost about 10 pounds. My info is with Cigna now so I am waiting to see if they will approve me. All I can say is keep trying and don't give up. You should write a letter yourself to be included in your file when it gets submitted to the insurance company. It can't hurt. If you want, I can email you my letter I wrote. I found a version online and followed the guidelines of it and I made sure I included all of the points that were required in my insurance plan. Email me at [email protected] if you want to see it. Stay positive (easier said than done- I know!). But keep trying for it. It will happen when it is supposed to happen. Good luck and keep us updated. Misty

Hi Cindy! I also am a patient of Dr Woodman's. I have Aetna POS Open Access which I believe is similar to your version of CIGNA. I have a co-worker that had the surgery done 1 year ago and during her 6 month medically supervised weight loss she actually gained about 8 lbs and she was approved on the first try. I don't think they will deny you just for gaining weight. On another subject, what is the name of the nurse that you have dealt with at Dr Woodmans office? Thanks, Karen L

I've only been once. The nurse I saw was Kelley! She was very nice. Cindy

He has a new lady who calls herself a nurse that handles sending all the stuff to the insurance company and she was absolutely horrible when I went in there on Tuesday.

I have CIGNA POS open access plan being an employee of the State of Tennessee....you should be ok, I lost about 15 pounds in six months, but it was on again, off again..... Cigna approved me the same day they received my packet, but my doctor did not get the call for 3 days, but 3 days is very short.......I googled CIGNA and found exactly what they were looking for... 6 months dr. supervised diet (dr. documents diet attempts, exercise suggestions, etc.****ep a food diary and gave it to my doctor to look at every month....he did not make it a part of the record, but he did add in his notes that he had reviewed my food diary.. Cigna also requires a nutritionalist visit, a psych eval and medical records for 5 years documenting your obesity. My BMI was low compared to a lot of people, only 42, but I was insulin resistant which made a turn in December to full blown diabetes....... The good news is I was approved, had surgery on March 7th and am down a total of 52 pounds since Christmas and 37 pounds since lapband surgery......My weight loss has slowed to about a pound a week, but I am happy, healthy and able to eat just about anything in small bites and small amounts.....I eat about 1000-1200 calories a day....no longer need insulin, metformin or lipitor...I am off all medicines except for my flintstones vitamin and my calcium... Never give up.....there were times, I felt like giving up, but this board was a great source of comfort and encouragement to me.....it will always be here for you.....success is just over the horizion.......you can do it.