Cigna PPO advice anyone???

Hi All...

I'm just starting this process to having the Realize Lap-Band done.  I have Cigna PPO...wondering if anyone out there can give me information if they've used this insurance company.  Looks like I'm going to use "out of network" benefits.  If you used "in" network, I'd love the advice too!!!

Thanks so much....
Kimi

Kimi

I don't have Cigna but I would highly recommend you make sure that your insurance does not have a weight loss surgery exclusion. Some of Cigna's insurance companys have this. Also post on the lap band forum with this question. More people are on that board.  You may have a high deductible with out of network.

i really recommend a center of surgery of excellence. This means that they have done a lot of weight loss surgeries and have met the criteria that Blue Cross Blue Shields for excellence. Its like choosing a restaurant that has a high restaurant score compared to one with a low. Do your research and look at all the surgeons in your area before choosing.

Call the insurance company and ask questions. Ask them if they have something on the internet that discusses weight loss surgery and the qualifications.

I spent 4-6 months looking into different programs and did lots of research.

Just had surgery on 1/22. Hospital has already been billed and paid. Dr's office also paid.


Tamara

I have Cigna. not sure if its ppo but heres what i had to do....

I did my 6 months diet plan-it was more like 12 months but i missed a few months, so had to wait till i had my 6 CONSECUTIVE MONTHS!

You need 2 years proof of being overweight.

you need a bmi of 40 or 35 with a comorbidity (and theyre picky! I had to gain weight to qualify!)

im not sure what else, but i was denied twice! I then had the actual surgeon call Cigna and do a peer to peer with a Cigna dr and was approved in like 5min!!!!

Only thing Cigna did not cover was the anasthesiologist! But it was only like $160

hope this helps.

I have cigna ppo expatriates. My doctor's nurse said they are a pain in the rear and she was right. I was denied twice but my awesome bariatric team worked magic lol.

If you haven't started the 6 months dr assisted weightloss get started. jenny craig and weigh****chers don't count with cigna. Either use your primary dr or if your bariatric Dr has a program use it. I was approved on the peer to peer because my doc argued that the letters never said consecutive weightloss just no significant gaps in months.

You also have to have 5 years (non pregnant) being obeise dr documented files and co morbid diagnose (if your bmi is under 40) high colesteral, sleep apnia, etc.

The rest of the info my Bariatric Dr's nurses put together for approval and scheduled me for all my blood and psych tests. March 17th is my band date woohoo. Almost 1 year from getting my first denial because i wasn't prepared from the begining. Most bariatric dr's wont see you till you have done the 6 month dr assisted weight loss or referral from your primary dr.

 

Hope this helps