*shaking fist* Curse you Cigna!
I finally got what I "thought" was the last of my documentation over to the DS surgeon. I figured that sometime this Spring I would schedule my DS surgery.
When I turned everything in I was told that the "documented weight loss program" would not pass Cigna's strict requirements. So the 6 month clock starts over again. I also have to meet with a dietition which will happen in Wed.
It's not exactly the outcome I was expecting but I'm happy I found out sooner than later. Thanks for all of the encouragement, it keeps me going in the right direction.
When I turned everything in I was told that the "documented weight loss program" would not pass Cigna's strict requirements. So the 6 month clock starts over again. I also have to meet with a dietition which will happen in Wed.
It's not exactly the outcome I was expecting but I'm happy I found out sooner than later. Thanks for all of the encouragement, it keeps me going in the right direction.
(deactivated member)
on 1/2/12 1:00 pm - VA
on 1/2/12 1:00 pm - VA
I am using Cigna, as well. If you don't mind me asking, what exactly was the issue? I'm curious.
I remember having to do this for Aetna when I was getting the Crap Band! I remember my monthly weigh-ins and meeting with the nutritionist (on my dime) ... felt like it was stupid and a exercise in futility... but I made it through... and though that was not the right surgery for me... my message is hang in there... you will get through it!!!
Original LapBand Surgery - 07/26/06- DS Surgery - 08/16/2011
HW/LW/SW/CW/GW
289/195/277.5/242.5/170
I'm sorry this happened, but hope your post will serve as a warning to others - READ YOUR POLICY FOR YOURSELF! Find out EXACTLY what is required. There are so many different policies with different requirements. Some insist that the 6 months (or however many months) be with a physician. Some with a dietician or nutritionist. Some will accept things like Weigh****chers, most won't. Some, if your monthly appt is off by 1 day, will not accept them and make you restart the whole process.
It isn't fair, but this stuff goes on all the time. The employees of the insurance company you may speak with on the phone are not your friends and are just doing their jobs. They don't care about you and whether or not you eventually have surgery. No one cares about this more than you, so read your policy yourself and make sure you do everything as required.
Larra
It isn't fair, but this stuff goes on all the time. The employees of the insurance company you may speak with on the phone are not your friends and are just doing their jobs. They don't care about you and whether or not you eventually have surgery. No one cares about this more than you, so read your policy yourself and make sure you do everything as required.
Larra
Were you told by Cigna or the surgeon's office? I ask because my surgeon's staff wasn't nearly as knowledgeable as they thought they were and tried to make me do a weight loss program that my insurance didn't require. If you haven't talked to the insurance people yourself, definitely do so.
Valerie
DS 2005
There is room on this earth for all of God's creatures..
next to the mashed potatoes
Well it really matters what the insurance company thinks when they get it. Do you feel you have a Good MONTHLY documentation on weight, diet program and exercise program of at least 6 months in the last 2 years? More importantly what I see is they have a 50 BMI requirement for DS approval. Your profile doesn't show you make that. Are you plans to submit and then appeal the denial? If so, you may want to start the process of the denial for that if you feel you have good diet/exercise program documentation from a doctor.
Good luck.
Tom
From CIGNA MEDICAL COVERAGE POLICY - Bariatric Surgery:
http://www.cigna.com/assets/docs/health-care-professionals/c overage_positions/mm_0051_coveragepositioncriteria_bariatric _surgery.pdf
• Failure of medical management including evidence of active participation within the last two years in a weight-management program that is supervised either by a physician or a registered dietician for a minimum of six months without significant gaps. The weight-management program must include monthly documentation of ALL of the following components:
- weight
- current dietary program
- physical activity (e.g., exercise program)
Programs such as Weigh****chers®, Jenny Craig® and Optifast® are acceptable alternatives if done in conjunction with the supervision of a physician or registered dietician and detailed documentation of participation is available for review. For individuals with long-standing, morbid obesity, participation in a program within the last five years is sufficient if reasonable attendance in the weight-management program over an extended period of time of at least six months can be demonstrated. However, physician-supervised programs consisting exclusively of pharmacological management are not sufficient to meet this requirement.
• A thorough multidisciplinary evaluation within the previous 12 months whi*****ludes the following:
- an evaluation by a bariatric surgeon recommending surgical treatment, including a description of the proposed procedure(s) and all of the associated current CPT codes
- a separate medical evaluation from a physician other than the surgeon recommending surgery, that includes a medical clearance for bariatric surgery
- unequivocal clearance for bariatric surgery by a mental health provider
- a nutritional evaluation by a physician or registered dietician
Good luck.
Tom
From CIGNA MEDICAL COVERAGE POLICY - Bariatric Surgery:
http://www.cigna.com/assets/docs/health-care-professionals/c overage_positions/mm_0051_coveragepositioncriteria_bariatric _surgery.pdf
• Failure of medical management including evidence of active participation within the last two years in a weight-management program that is supervised either by a physician or a registered dietician for a minimum of six months without significant gaps. The weight-management program must include monthly documentation of ALL of the following components:
- weight
- current dietary program
- physical activity (e.g., exercise program)
Programs such as Weigh****chers®, Jenny Craig® and Optifast® are acceptable alternatives if done in conjunction with the supervision of a physician or registered dietician and detailed documentation of participation is available for review. For individuals with long-standing, morbid obesity, participation in a program within the last five years is sufficient if reasonable attendance in the weight-management program over an extended period of time of at least six months can be demonstrated. However, physician-supervised programs consisting exclusively of pharmacological management are not sufficient to meet this requirement.
• A thorough multidisciplinary evaluation within the previous 12 months whi*****ludes the following:
- an evaluation by a bariatric surgeon recommending surgical treatment, including a description of the proposed procedure(s) and all of the associated current CPT codes
- a separate medical evaluation from a physician other than the surgeon recommending surgery, that includes a medical clearance for bariatric surgery
- unequivocal clearance for bariatric surgery by a mental health provider
- a nutritional evaluation by a physician or registered dietician
HW 341/SW 309/CW 169/GW 190 172 lb. loss with my DS - Subscribe to me on YouTube!
Plastics with Dr. Sauceda 1-11-11 Lower Body Lift, Thigh Lift, Upper Body Lift, Arm Lift and Male Breast Reduction
If you are a MALE and are interested in MALE PLASTICS AFTER WLS click to join our OH Group!
Most Active
Recent Topics
