I have been denied by Cigna PPO

When I first contacted Cigna PPO, back in May, 2003, I asked them what I needed to do to be approved for Lap RNY. At that time, they advised me that all I needed to do was send a letter of medical necessity to them. I did this. At that point they said, this letter isn't enough -- we need to have a psych evaluation proving that you're ready for the emotional changes that occur from surgery as well as a confirmation that you're of a sane mind. ha I did this. Then, they said -- you need to speak to a nutritionist and be taught how you will need to eat after surgery, what your daily menu will be as well as given a list of foods you can eat and foods you can't. I did this. Then, they said, you need to provide a diet history for us so that we can see that you've tried other resources to lose weight. I did this. Which brings me to today. They told me I needed to attend a weight loss center for 26 weeks and document monthly weigh ins during this period as well as keep a daily journal of exercise. I'm so frustrated and disappointed. Another 6 months of living in pain. At the end of this 6 months ... what will they want?

This is Cigna's last effort to avoid the cost of helping us overcome our obesity and related health problems. I have heard that beginning in Jan 2004, Cigna will exclude WLS from policies. That means that in 26 weeks, once again they will deny based on exclusion. This may or may not be true, I am just letting you know what I have heard. I myself am dealing with Cigna , and they are truly amazing(in a bad way)!!!Do not give up. I urge you to hire an attorney and proceed with this at this time. I have spoken with several people that have been approved despite this 26 week diet scam. I do not know your history, but if you have dieted alot in the past, you probably have a chance. Good luck.

Angela, I am sorry to hear that you are going through the same insurance hell that CIGNA seems to be putting everyone through. I am VBG hoping to revise to an RNY. I took a job 80 miles away because I had heard CIGNA covered WLS. They did not pay for my original surgery so it's not like I am double dipping or anything. My VBG was self pay and at present that is not an option. I did everything that they asked pscyh evaluation, sleep study and nutrition consultation. When my surgeon applied for preauthorization they whipped the 26 week diet attempt crap on me. Actually my letter said I needed 2-26 dr. supervised diet attempts, one within the last year. So I appealed it. Explaning that with the VBG it is impossible to follow any kind of healthy eating plan. I thought that surely since dr.'s would be reading this appeal they would understand the implications of the VBG. Mainly the fact that you vomit most foods up. Anything that would be considered healthy anyway. With CIGNA you can request a peer-to-peer review, where your dr. can basically argue your need to have this surgery with one of CIGNA's dr.'s. I called my surgeon's office and asked for him to do this. So far he hasn't. When I called back to check his office staff told me that "we can't force him to do it, but we will put another note on your chart is in his office". To finish up this long story there is a job opening available in my hometown that would save me driving 3 hours daily to my job and $200 a month in gas. The downside is the insurance I believe is pretty bad. Healthscape is the insurance and I know nothing about it. My surgeon's office did mention hiring a lawyer in San Diego to fight for the surgery. Apparently you pay him a $500 retainer and if he can't get your surgery approved you get the $500 back. When I read the other post about CIGNA excluding WLS in 2004 I thought that sounds about right. By the time I started a 26 week dr. supervised diet and completed it, it would be February. So what to do next I am not sure. I am telling my surgeon's office he needs to call so that I can either go with another surgeon who actually cares enough be involved or hire the attorney. I don't see that I have any other options. Well, reversal I guess. But I am so afraid of gaining more weight. I wish you the best, Piper

WOW sounds like Cigna PPO was busy last week. I too was denied on Friday 8/15. They said my diet history...even though one 26 week period had been Jan-Jun of this year on diet medication....was not enough to support this. I have asked my PCP to call for a peer to peer consult and I believe he will. If that does not work I am going to get an attorney. I have followed the guidelines and given all the information that was requested. I am tired of them. Once I get a final answer one way or another I will be writing to Cigna and the insurance review board as well as the insurance commission regarding this matter.

I am just waiting for my denial letter from Cigna and the diet for 26 week clause. I doubt it wil ldo any good but my response to them (and my doctor will back me up on this) is that my policy states they will cover this procedure for medical necessity. There is no clause that I need to be forced into another diet program. If anyone knows how to contact the insurance commission please let me know!

I too have been denied for precisely the same reason - I do not have 2-26 week weight loss programs documented. As of today I have retained the help of that "San Diego Attorney". You can find his information at http://www.obesitylaw.com. I called prior to agreeing to retain him, just to find out his opinion on the chances of an appeal with Cigna. He basically said what will happen is that we will need to appeal twice, and usually on the third attempt he has had success. I find it appalling that an insurance company who was approving people regularly prior to last April (see the information at http://www.obesityhelp.com) has suddenly decided to make it so darn difficult to get approval. I would not be suprised if they did an exclusion.