Confuzzled about CIGNA requirements
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.
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.
I went to the office today and provided her with a copy of CIGNA's criteria, new and old. I highlighted the changes for her and we discussed what it says. The next time she calls them she is going to conference me in. I also provided her with more history and they are aware of my comorbidies. I am crossing my fingers majorly
Cigna change the criteria in May 09 only need the six month diet. and 1Co-Morbidity with 35 bmi and only the 6 month with 40 bmi.
wendy
wendy
Wendy
1st fill 4cc, 2nd fill 1.5cc 3rd fill 1.5cc 4th fill .5 Total 7.5 cc in my 11cc Realize Band.
Reached 1st goal weight 158 on 6/8/10, My Starting weight 235
Hit final goal of 145 10/25/10
Current weight 143
If you work the band the band will work for you.
1st fill 4cc, 2nd fill 1.5cc 3rd fill 1.5cc 4th fill .5 Total 7.5 cc in my 11cc Realize Band.
Reached 1st goal weight 158 on 6/8/10, My Starting weight 235
Hit final goal of 145 10/25/10
Current weight 143
If you work the band the band will work for you.
I also have Cigna and I called them yesterday and they verified that I only need 6months of weigh ins with my primary care Dr. and not the 24months before that..I called the surgeons office and the insurance person said that cigna always asks for the 24month plus 6month reports....i will call her tomorrow and advise her of the revision in Cigna's policy. That helps me out alot because my Dr. for last two years closed up and I can't get my records for 2007 and 2008...thanks for your post!
I have cinga and so I hunted down some posts by the onsite search engine that delt with them. I want to ask and make sure that I'm understanding this the right way since this is what is stressing me out soooooo much.
All I have to have for Cigna is 6 months of me working with my dr to lose weight. I do not have to show 24 months of weigh ins?
How was Cigna, I'm so worried that they are going to give me a hard time since I'm right at the cut off for BMI...
All I have to have for Cigna is 6 months of me working with my dr to lose weight. I do not have to show 24 months of weigh ins?
How was Cigna, I'm so worried that they are going to give me a hard time since I'm right at the cut off for BMI...
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