Cigna of NC

I received my denial for my first letter. It states that the "benefit for bariatric surgery based on medical necessity" is covered. However, there is no documentation showing that I have been in "active reasonable compliance with at least 2 profesionally supervised weight loss programs of at least 26 weeks, one of which was within the past 12 months and documents at least monthly weight-ins." I have been on three medically supervised diets in my lifetime one at age 12; one in 1982; and one in 1995. In addition to those I have been on Weigh****chers at least 4 times; Diet Center; Atkins; Protein Power; World Gym's program of weight training and diet (1999); and Gold's Gym's Intrafit weight training and diet program (2000). How many times do I have to fail at losing and keeping my weight off before it is obvious that conventional dieting is not working? I am 42 years old. I have borderline high blood pressure; swelling in the legs and feet; depression; degenerative disks at L4/L5 and am 274 pounds. I meet the criteria short of being on a diet of 26 weeks within the last year. I wonder what the criteria was a year ago. I started the evaluation process with my surgeon in March 2002. I need help. I'm so upset.

Well you can say I was the luck one . I got my denial on one day I called them and left a message they called me back the next morning i told them what i was having done and why i turned in several years of documentation from my drs showing were i have been overweight she called me back that afternoon with my approval . If you have any questions email me at ccemsdtrammel@yahoo

Hi Judy, Im sorry to hear about what you are having to go through. I found that end of April, Cigna modified and added the requirements with the diets. When I started my journey in January, it was not part of the necessities to be approved. I am frustrated, angry, tired and just OVER losing weight with a diet only to regain! I would contact the lawyer that advertises on this site who specializes in denials and see if he cant help. Please keep me afloat on this, as Im sure I will be going through it in September Good luck to you! Judith ~ [email protected]

Man oh man, can I relate to you all and know your frustation. CIGNA just pulled the same crap with me. The first time I was denied, I recieved NO denial letter. I filed an appeal, again denied on 5-15-03. The letter stated NOTHING about 26wks of monitored dieting. They wanted more info from my pcp, a sleep study done and a psych eval. So I'm almost done getting those things done and to fax my appeal in. Then on 6-23-03 they all the sudden send me a letter stating they need 26wks of dieting. What a bunch of B.S. My policy is renewed Jan 1st of every year. How can they leagally just decide out of the blue to change their policy mid year??? I am so pissed. If they deny me again, Im going to my state medical commition and/or hire an attorney. I have had it.

Hi this is bobbie. I have was denied in APril because of a psych eval that I needed and a dietician consult and she said to send in all documentation of at least a 12 months worth of diets that i had tried. Well I did all of this in May and even sent a Drs. note. On may 27 they denied me again. Of course this is now July 13 and I still have not recieved a letter from the insurance company saying they denied me. I made a phone call to them around the end of June and ask them the status and they told me. Then I called Bobbie lou at the Drs office she too then called them and they told her it was denied. Well I immediatly called them back and told them I wanteed to appeal it. I am senind in an appeal. By the way I too have Cigna. MY BMI is 50 I have obstructive sleep apean, hypothyroidism, asthma, gerd, hiatal hernia, chronic back pain that is documneted and just recently have been put on medication for pain in my knees. The Dr thinks I may have fibromyalgia. I see a specailist next month. the basis for denial is the 26 week weight loss documentation. I too think this is just wrong. I mean why do they wait until you are dying to try to help., Well keep praying and cross your fingers maybe one of us wll get an approval. Email me at [email protected]

judy, my story is a little different. i have bc/bs of alabama, which pre-certifies through intercorp. i got my 1st denial from them stating that i needed 26 weeks of supervised dieting in the last 52 weeks..my ob/gyn wrote a letter with 4 months of dieting this year on prescribed phentermine. i then recieved my 2nd denial, stating that according to "cigna" criteria, i have to have to 26 weeks and a post-surgery support group(i have) and a fitness program(been in that last 2 years). i called and rep told me that must be a mistake i have bc/bs she would call me back, didn't happen...i called them back the next day and a different rep told me they use "cigna's" criteria for wls surgery. i am furious the game keeps changing, but i am doing the 26 week thing and will provide them with the support group and fitness info(although this is the first time i've heard this from them. i also called them each time from work which is a government job and has recorded phone lines, if denied this time, i will contact a lawyer