Please help!!! Anybody had CIGNA?
I posted this on the Insurance Board but haven't gotten much of a response yet. Here is my issue:
Today my Doc ofc called and stated that they contact CIGNA to be sure I had everything in place before they submitted for approval. The ofc mgr said that CIGNA said that my weight loss history was not going to help. See, I have more than four years of doctor supervised weight loss attempts. Yes, a sista was seriously trying to drop some pounds. I did it (always losing 70lbs) but gained it back (always gaining +5). My most recent doctor supervised weight loss attempt ended on 01/09. So, the nurse is telling me that CIGNA says that since my most recent weight loss attempt was 01/09, I would not be able to have the surgery until 01/11....making it two years from the date of my last attempt. Now excuse me, but that sounds like some BS. Here is what the CIGNA policy dictates:
Failure of a medical management including evidence of active particinpaion within the last two years in a weight-management program that is supervised either by a physician or a licensed dietician for a minimum of six months without significant gaps.
NO where in this does it say that the diet must have been two years out from the six months. That does not make sense! Anyone else dealt with CIGNA and this? I am so confused and don't want to give up on a technicality.
I must also add that I called CIGNA myself and spoke with a rep named Katie (who would not give me her ID). She explained it just as I interpreted it. As long as I have gone to a dietician within the last two years AND had a least six months of supervised diet then it is all good. This office manager is in charge of sending my paperwork over to CIGNA. Should I ask to speak with someone besides her since she seems confused by this? I don't want her to not send in my paperwork because she is not speaking to someone who is not making it clear to her. She says she is not sending it over until she knows it will get approved and keeps suggesting that I do six months with their office. She is new also. PLUS CIGNA updated their policy on 06/15/09 not even requiring two years history any longer. Could it be that she is looking at an old policy and probably did not even speak to CIGNA just to make sure that I have all of my paperwork?
Sorry for the bombardment of questions. I am truly concerned about this.
Today my Doc ofc called and stated that they contact CIGNA to be sure I had everything in place before they submitted for approval. The ofc mgr said that CIGNA said that my weight loss history was not going to help. See, I have more than four years of doctor supervised weight loss attempts. Yes, a sista was seriously trying to drop some pounds. I did it (always losing 70lbs) but gained it back (always gaining +5). My most recent doctor supervised weight loss attempt ended on 01/09. So, the nurse is telling me that CIGNA says that since my most recent weight loss attempt was 01/09, I would not be able to have the surgery until 01/11....making it two years from the date of my last attempt. Now excuse me, but that sounds like some BS. Here is what the CIGNA policy dictates:
Failure of a medical management including evidence of active particinpaion within the last two years in a weight-management program that is supervised either by a physician or a licensed dietician for a minimum of six months without significant gaps.
NO where in this does it say that the diet must have been two years out from the six months. That does not make sense! Anyone else dealt with CIGNA and this? I am so confused and don't want to give up on a technicality.
I must also add that I called CIGNA myself and spoke with a rep named Katie (who would not give me her ID). She explained it just as I interpreted it. As long as I have gone to a dietician within the last two years AND had a least six months of supervised diet then it is all good. This office manager is in charge of sending my paperwork over to CIGNA. Should I ask to speak with someone besides her since she seems confused by this? I don't want her to not send in my paperwork because she is not speaking to someone who is not making it clear to her. She says she is not sending it over until she knows it will get approved and keeps suggesting that I do six months with their office. She is new also. PLUS CIGNA updated their policy on 06/15/09 not even requiring two years history any longer. Could it be that she is looking at an old policy and probably did not even speak to CIGNA just to make sure that I have all of my paperwork?
Sorry for the bombardment of questions. I am truly concerned about this.
You either need to speak with someone else in the office or find another surgeon willing to submit your paperwork - looks like you are on your game and they aren't either one theirs or willing to work with you - either way - you gotta do what's best for YOU.
I had Cigna myself and did the whole routine of jumping through hoops- so I feel your pain.
I had Cigna myself and did the whole routine of jumping through hoops- so I feel your pain.
I don't just have issues, I have subscriptions! I'm saving on the newsstand price....... 
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Who did you speak with? I think Shelia took care of my paper work. All I know is she submitted it in Friday and Monday I was approved. If I were you I would go to the office and sit down with her whoever she is and go over the policy and let her know you are stressed because financially this is a longer burden than you had expected. My experience with the office is once you speak straight up you will get good results. You need to get a copy of the policy and take it with you the new policy. Believe me the doctor don't want to lose any patients we are how they make there money it must me a misunderstanding big time. I do know they have a good weight loss program for the six month because I have met a few people that we on it. Just try to be calm and everything will work out.
Lady, I go in there so much they start closing shop when they see my car pull into the parking lot (lol). I always get names for anything I drop off and ask for extra copies. I think I am going to just go in and speak with TIna this afternoon and do a conference call with CIGNA so we both understand clearly the criteria.
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