I am approved!!! CIGNA & BCBS of TX TRS

It's a miracle! Thank you to everyone on this board for your support.

I have CIGNA PPO through my husband. They approved me in 1 week. I cannot believe this b/c I tried with them 3 years ago and they were so picky about everything. A real pain. I ended up giving up. Make sure the Dr. documents diet, exercise, diary, weight, everytime.

I have BCBS of TX TRS for teachers through my ISD. They took 2 weeks to approve me. Their main thing is the supervised diet also. They were always very nice to talk to. I only called 2x.

I am so happy, but nervous also. I guess I know change is coming and it's new and a little scary. Oh well, I'll get over it. I know I am so lucky to be approved.

Sara

Sara,

Have you already done your 6 month diet or are you starting it now?

I'm curious because I'm trying to figure out at what point in my process I should submit my info to insurance for approval.  I'm doing my 6 month diet now.

Thanks for sharing your experience,

Sharon

Sharon,

 I'm happy to answer any questions I can.

I finished it in June. My doc's ofc (Dr. Dean McDaniel in Victoria) wouldn't submit until everything was done. I think it's a good way, just be sure what your policy requires.

I had some problems in the past with Cigna, but I looked up their requirements on the website and made sure I did everything. My approval was pretty fast.

They can all be picky about what needs to be documented in the notes, so be careful.

I am trying to change surgeons to Garth Davis. Mine wants an extra $3000 after my ins pays-he's out of network...  That's a lot of extra money in addition to the $5000 max out of pocket. I have to find someone in my network.

Sara

Sharon,

This is what Barbara C. posted on July, 20th. It's very good advice.


If you need to have a medically supervised weight loss attempt, be sure to check with your insurer to find out exactly what they want to see in the clinical notes and then communicate that information to your health care provider. My husband's insurance requires:

vital signs, ... i.e., weight, blood pressure, etc...

discussion of weight loss program being attempted ... i.e., portion control, logging of foods, weight loss meds., high protien/low carb diet, etc...

discussion of exercise program being attempted ... i.e., walking 30 mins 3 x week, resistance training 30 mins 3 x week, etc...

discussion of behavior modificatons being attempted ... i.e., counseling sessions, attending support group meetings, working through a behavior modification program, etc...

results of attempt ... i.e., loss, maintained, gained X lbs.

I hope that if you require a documented weight loss attempt you will find out not only what the insurer wants but what is being documented at each visit so that you can avoid the disappointing and costly mistake we are dealing with now. Now we are getting a copy of each month's clinical notes. They are being submitted to our program for review so that if there is a problem it will be caught early on

Good Luck!

Sara

Congratulations, I also have CIGNA PPO but have been waiting for 3 weeks for approval and still no answer.  Today was suppose to be their deadline, but I did not hear anything.

Good luck on your upcoming surgery and I hope to be joining you on the loser's side.

Karen,

I don't know why it was so quick. They are the ofc out of Chattanooga (sp?). They are my secondary, so maybe that's why???

My husband's company is self ins and Cigna administrates the policy. But, you still have to follow Cigna's guidelines...

Good luck to you. Let me know how it turns out.

Sara

Hi Sara,

Mine is out of Chattanooga as well.  I called them today and every time someone calls, the waiting period goes up.  It was a 15 day turn around after receiving the paperwork and now it is 30.  Oh well, maybe some day.

Karen

 

Karen,

A nurse from Cigna called me this morning. She says she will be my case mgr. She told me it's unusual to get approved that fast-that my paperwork must have been very easy for them to go through and everything right. She said it usually takes 25-30 days in the summer b/c they are sooooo busy. Also, when the paperwork comes in, it goes to a clearing house and then to the people *****view it. It could be that your area is busier than mine.

Bonnie on this forum had said only to send what they were asking for and that's what we did, although I did write a letter, basically outlining my comorbids, what I'm doing about them, and how well those interventions are working. I wrote the letter and took it to the docs ofc, then that night read what Bonnie said about personal letters. Her ideas made a lot of sense to me (she says don't bother, they don't have time to read them and it won't make a difference anyway; either you meet the criteria or you don't). I called the doc's ofc first thing next morn and they had already sent it all off. LOL!!! Anyway, I think that was the only "extra" thing in there.

I know this is a nerve wracking time for you. I was a basket case: couldn't sleep or concentrate! It won't be much longer though. I'll be saying a prayer for you every night.

Sara

Sara,

Thank you for your kind words.  I am always excited to see someone approved and starting their journey on the losing end.  I wish you well and look forward to hear about your accomplishments.  Keep us informed.

Karen