Cigna Insurance questions

I started my WLS journey in March. I haven't posted anything, but I have been reading a lot of helpful forums. I'm  getting closer to my surgery date (July 25th) if all goes well with the insurance. 

I wanted to find out from those who have had WLS if you have Cigna insurance. I have to have AT LEAST 89 days of monthly documented visits to my doctor, show an exercise and diet plan, psycho. eval., visit with a dietitian, a Recommendation letter from another doctor, other then the Surgeon.

Was there any other "hoops" you had to jump through to get the surgery approved? Now that I'm getting closer to date I will be submitting my paperwork, I'm getting nervous that I'll miss something or I have to prolong the surgery.

Thanks for all your help,

I don't have Cigna, but my plan also required a sleep study to rule out sleep apnea and clearance by a cardiologist.

Cigna might have 100, or even 1,000 different plans. It all depends on what the employer paid for. The only way to really tell for sure is to read the fine print on your policy. You can call Cigna or ask your surgeon's office, but sometimes they give out wonky information.

Each plan thru Cigna has different guidelines. It also depends if your employer funds your health insurance company. 

This should have most of the needed information https://cignaforhcp.cigna.com/public/content/pdf/coveragePolicies/medical/mm_0051_coveragepositioncriteria_bariatric_surgery.pdf

However i would recommend you check your policy and/or call Cigna @ 1- 888-992-4462 and ask for the requirements for WLS specific to your plan. Every call that comes into Cigna is documented in their computer systems.

Good luck on your journey

Thanks for the information. I've been doing all that. I'm just worried, about the documentation about current diet plan and exercise plan. My doc has been so blah-say about it...I even gave him a copy of the requirements...I guess I'll find out in a few short weeks what I did right or wrong :/

Thanks for the help. 

As long as you have kept a log of your daily foods and intake and exercise plan you should be OK. I too have Cigna and i work for Cigna, i had no problems getting my surgery covered. I just followed the information in the link i supplied you and it was good. Just make sure you have had 1 meeting a month with the DR for the 3 months that is required. 

Sounds like you have your ducks in a row. 

I have Cigna and no matter what plan you have, I would STRONGLY suggest that you ensure your PCP documents the words I recommend _____ for WLS.  My surgery was initially denied because those words were not included in her letter of clearance.  Also be sure everything that is required has been done and results are in the paperwork going to the insurance.  Cigna is a stickler when it comes to requested information.  I had done a sleep study last year when I started the process in another state and they required that I show that I had regularly used my CPAP before approval.  It can be a lengthy process with them, but if you have your documentation, you should be ok. 

Oh, and I recommend that if you are denied (and you very well might be), only have the surgeon's office send them what they are requesting in the denial letter.  My surgeon's office sent 58 pages to the appeals office and they delayed my approval and entire month. 

I had heard horror stories about Cigna, but I can't be more happy with them.  We met our deductible in January, so everything is covered. 

Petetrox, what I'm worried about is the "documentation" of diet and exercise plan. Did you go to Weigh****chers? I did not.  I"m on my 90 days minimum of doctor's visits. I'm just not sure if I need to weight all my meals out (which I have done) or if it's up to the PCP to document that in our monthly visits.  

How long did you have to use your CPAP? I also did a sleep study and have a CPAP. I have heard of other insurances forcing 3 mos on a CPAP machine before surgery. 

I'm been to a dietatian, psych eval, sleep study, and 90days with my PCP for weight, diet and exercise...I don't know what type of documentation they actually WANT for the diet and exercise thing.

How long did this whole processes take you Petetrox? I started the doctor visits in March...I"m hoping to have my surgery July 25th if Cigna will let me ;)

Thanks for your help I do appreciate.

Monet  

I also have Cigna, but they required six consecutive months of supervised weight loss and were quite particular about the dates.  So, if my first appointment was on May 15, I was required to see the doc again by June 15. Even 1 day late, I'd have to start the consecutive appointments over again. It made the winter months stressful, as I was always worried about snow storms.

I also had to show proof of my CPAP usuage by bringing in the memory card. I can no longer remember how long I had to use it, though. 8 weeks maybe?

My surgeon's office provided the grid for the PCP to use. It had 4 lines for the initial weight and subsequent weigh ins. It also had a column for what methods are being used for weight loss, one for exercise, and the doc's comments. It was very simple and served it's purpose.

All offices are different but my surgeon's office compiledand sent all information to the insurance. I decided to go ahead and start in my new city and had my first appointment on Feb. 25th. Everything was submitted the end of April, more info sent on May 3. Sat on someone's desk at Cigna until June 1 when it was approved.

I had a June 6 surgery date, but had to postpone because we didn't have approval in time. Surgery is now scheduled for July 13th.