CIGNA 6 month medical weight loss requirement

I just got my first denial letter based on CIGNA needing additional information from my surgeon as well as a letter from at least one other physician stating that I need to have surgery.  They are also requiring the 6 month medically supervised weight loss program.  When I first contacted CIGNA back in April I asked them if Weigh****chers was sufficient and they said it would be, now they are saying it's not accepted, it has to be documented by a doctor.  What a waste of my time!

My question, has anyone ever been able to get CIGNA to waive that requirement?  Just in case, I am meeting with the nutritionist on Friday to start a program but I'm hoping that we can either lessen or waive the requirement. 

I have a BMI of 60, I have sleep apnea, high blood pressure, joint issues...I'm 35 years old and I've tried every weight loss program under the sun.  What more do they want?!?  Sorry, just frustrated right now.

I have my PCP and OB both writing letters and I'm going to write a letter as well as the Bariatric Nurse.  Hopefully we can make this happen but please let me know if you've had any experience or success getting this waived.

Thank you!

Erica

It is my understanding that you just cannot get out of this. And don't miss a month or you may have to start over. Start now and it goes by quickly! You have many other things to take care of before surgery too, so it all takes time. Good luck.

On the document on Cignas own website it states that Weigh****chers is sufficient. Not sure if this link will work but here it is.

http://www.cigna.com/customer_care/healthcare_professional/coverage_positions/medical/mm_0051_coveragepositioncriteria_bariatric_surgery.pdf

The info is on page 2. "It does state it needs to be in conjunction with a physician or registered dietician." then followed with "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"

You may be able to appeal.

Ericha2, did they elaborate on how it was to be documented by the doctor? I have Cigna as well and this 6mo requirement is my biggest fear. I have proof from Jenny Craig that started in 4/2009 till 10/2009 which I'm hoping they still consider within the previous 2 year mark but I didn't do it with a doctor.

I really hope others post their experience with this, a 6 month delay would be so disheartening

I have cigna as well.  I was denied with weigh****chers orginally and have a long standing history of morbid obesity for the last five years. 

I started my medical supervised program and missed the final appointment of my 6 months due to scheduling.  I rescheduled it for the following month, but my Cigna Health Advocate told me that I had to restart again.  I will finish in December of this year, but I am doing all the pre surgery appointments at the same time.

The most important line in the policy is: 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. 

According to the nurse coordinator at my hospital said "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" still has to have the medical guidence diet for six months, they just increase the overall year requirement of five years vs. two years. 

Best of luck!  At the end of the day, during those six months you will learn how to adapt and work towards new eating habits to ensure you success post op.