Insurance ? about Cigna POS? Please advise.

Ok, my ins is through my husband who works for ABC which is owned by Disney. I pulled out the summary plan packet. Now, the advice the surgerons office told me was that B4 we do paperwork she knew that Cigna would want me to that proof that I was under supervised diet for at least 6 months, ok. I pulled out the packet that I looked at in November & it states what expenses r not covered. It says: Nutritional counseling, except for one consultation with a dietitian or nutritionist upon the diagnosis of malnutrition or diabetes. ok, that's listed under the category of expenses that r not covered under the Cigna POS plan. Now how the heck do they expect me to have proof that I am under a supervised diet plan by a RD for 6 months if they won't pay for it. Because that's what it sounds like to me. I think that is just a tactic that they use to discourage someone, hey even if they didn't want to pay for WLS at least U would think that would want U to try to loose weight, to be healthier, to have to pay out less claims. It's a conspiracy I think. & they would only cover 1 consult if I had a DX of MALNUTRITION or DIABETES!!! But if we're Obese tough luck?? It has to be a conspiracy, they must own shares in Health Clubs or programs like Medifast, Nutrasystem..etc...I think they want to get "FAT" off our $$$. It also says under what's NOT covered: Services or supplies related to obesity or weight loss, including appetite suppressants, diet centers, dietary supplements and weight loss programs, except for covered treatment of morbid obesity if such treatment is determined to be medically necessary. Hey, what do they think that I am some loaded housewife in a size 6 dreaming of being a size 2?? They must have rocks in their head!! I have a feeling that I am in for some drama...

Hi Raquel I had surgery on 11/24 and was covered under Cigna POS. It was a complete nightmare and took me a year, 2 appeals and my company lawyers to get their denial overturned. You have to fulfill all of their requirements!! You can check my website and read my online journal which will tell you in detail everything I went through with Cigna. You can get to my website through my AMOS profile or just click here http://hometown.aol.com/armsofurangel/page2.html/ . Also there is a Yahoo group http://health.groups.yahoo.com/group/Cignassqueakywheels/ that will help you also. Best of luck to you, DON'T GIVE UP!! And email me if you ever need to talk. Susan LAP RNY 11/24/04 -47 lbs.

Raquel, The good news is that your husbands insurance does not exclude WLS like most CIGNA policies do. Usually CIGNA wants the supervised diet to be at least 6 months of a medically supervised diet with monthly weigh-ins. I would suggest you contact your PCP for diet supervision, explaining you are contemplating WLS if this diet fails, and that you will need WELL DOCUMENTED monthly weigh-ins. You must convince your MD (and CIGNA) that you are seriously dieting during this time. You will also need the diet documented, etc. You can get more details of their criteria for approval from the benefit plan booklet from HR. Good luck, JG 284/154/149?

TX, my PCP is the one that said for us to investigate that route back in November, after I had the baby I just went in for a check up. But since I told him about Cigna he gave me a referral for a RD but I think I should also make monthly appts with him and discuss everything & get my weight & such documented. He's been my PCP for the past 13 yrs, so he has my past HX documented to go by. I was just wondering if there was anything else that I should pay attention to or have prepared. Maybe another MRI on my back to check if my discs have gotten worse I know they haven't gotten any better but I think I should wait until maybe 30 days B4 we put in my paperwork otherwise they may say it's not current, my last one was 1 1/2 yr ago. Same with my knee. I don't know if I have sleep apnea? my hubby says that I snore alot but I guess alot of people do.

Raqual, Most insurers just care if you meet their criteria for WLS, usu just the proof of proven diet and weigh-in for a # of months. They will try hard not to approve you, and you might be denied the first time, as they like to do that just to see who they can discourage. However, others do get approved without any problems. Co-morbidities are helpful to your PCP and bariatric surgeon for them to qualify you for WLS. A visit to a sleep clinic to determine if you do have sleep apnea, however, is essential to your health, so you should look into that. Once you choose your bariatric surgeon, his office person can probably best fill you in on what you need and what their own experience with CIGNA has been. In the mean time, see that RD and get a diet to follow, and then see your own PCP for the monthly weigh-ins and follow ups. Keep me posted. JG