6 mo diet-Cigna CA PPO ?'s

Happy New Year Everyone Still confused I've been trying to get approved since 7/05. Got a letter in Sept. that said I need 6 mo supervised diet. (No Weigh****chers/Jenny Craig, etc.) I'm about 4 1/2 mos in and I get a call from my Dr.'s office. They gave me an atty's # and said I should call and start an appeal. I got a post from someone that said it's illegal to require 6mos diet especially considering I had met all the other requirements!! Any suggestions and advise would be greatly appreciated!! AJ

You have been given some inaccurate information. 1) It is not illegal for Cigna to require documentation of a diet. All the major carriers do. In California, if you have an HMO, you can't be required to do the diet, because the California Dept of Managed Care issued a statement that there is no rational reason for the diet. However, since you have a PPO plan, that doesn't apply to you. 2) You don't need an attorney to file an appeal. Finish the 6 month diet, and have your surgeon's office send copies of your diet documentation to Cigna. Make sure that your physician who supervised the diet document ad nauseum, that at every visit you were counseled on nutrition, behavior modification and exercise, and exactly how many calories you ate. Also, the type and frequency of your exercise program. Make sure you have monthly visits, and don't miss any.

Hi Roberta, Thanks for your reply! It was very helpful! This insurance thing is so confusing. I know every case is different so I will continue with my monthly visits. My question is what is nauseum? Thanks again AJ

Hi Roberta long time since I have seen you post or is the fact that I don't hang out here much anymore Donna Chu 338/159

You do not need a full six months in California. Period. You do need proof you have tried and failed diets. If you are told otherwise it is completely incorrect. Unless it is a self funded plan. You should appeal now while you are doing a diet, because six months becomes 7 when they tell you one month was a consultation. And you do not need a lawyer or anyone at all to file an appeal. You have the legal right to file one, and in California the right to an Independant Medical Review at the completion of your appeals. Best of luck Gary Viscio RNY 7/1/03 www.obesitylawyers.com OH Advisory Board

Thanks Gary, I appreciate the info! My Dr.'s office submitted my diet info (Jenny Craig-almost 7 mos) My BMI is 40.24 I have bad kness, back pain, PCOS, acid reflux and my feet hurt constantly!! I've done every diet there is but don't have the "proof" they are looking for! How do I file an appeal? Thanks for all your help AJ

Done deal. Hope my email answered your email. And you'll notice I didn't suggest you should hire me or anyone else. I don't troll for business. People can file appeals on their own or hire an attorney. It's their choice. Either way I wish you didn't have to appeal period and wish you all the best. Gary