Question:
Cigna HMO -HELP!!

1-1/2 months ago I was told that Cigna HMO required a 3 month supervised diet before considering WLS. My PCP put me on Meridia + low cal diet. Now the surgeon's office says Cigna NOW requires a 6 month diet without any medications. Does anyone know the real skivvy? I don't want to do one only to be told I then need another 6 months. Sign me...Tired of the run-around!    — Patricia A. (posted on May 9, 2003)

May 9, 2003
Have you tried calling Cigna yourself? I just had my surgery Apr 3, 2003. I had no problems.
   — TLLessor

May 9, 2003
OK, here's the deal...I think we were ALL (all of us, meaning CIGNA "guinea pigs" here!) being told that is is "required". (also view Melissa's Q & A post on this back on I think, the 5th or 6th??) I called CIGNA myself when I first began this journey, on two seperate occaisions, and with two different gals, and asked EXACTLY what the requirements were..long story short, not ONE of them stated a dieting requirement. (And this was AFTER the supposed new "diet ruling" on the first of this yr) I wrote their names, and the time/date of the call. (If you don't already keep a log of calls, appt's and such, I WOULD!!) So THEN, I attended my seminar and hear they "REQUIRE" it. Bottom line, I have seen it go both ways. Get your co-mobidities documented and go for it. Some go through hell and back, and some get approved without a hitch. I have seen NO rhyme or reason to their "approval Process". Yes, it IS very frustrating.
   — [Deactivated Member]

May 9, 2003
I am the Melissa she is referring to. When I was approved in 12-02, I called Cigna and they informed me on two different occasions that they do not have any general requirements that apply everyone other than "medically necessary". I was told they determine approvals on a case by case basis. Once you submit your info, (Dr records, psych eval, your letter explaining your co morbidities and how it effects your daily life and your diet history) they will then determine if they want a supervised diet and for what duration. I was told by my Dr. that I would need a supervised diet before we submitted my information and he also told a room full of hopeful obese medicare patients that medicare does not cover WLS. Both of these were wrong and Im sure most of those patients just took his word for it and gave up to die of obesity. If you need information about what your insurance covers, go to them directly. Your Dr. is not the authority on this. If your Dr. gives you a hard time get the requirements in writing and then take it to him. If he still balks you might find out that Cigna is not reimbursing him enough to satisfy him and you need to find another Dr. Knowledge is power, empower yourself!! Good luck to you and if I can be of any help please email me.
   — missysworld

May 9, 2003
As far as cigna goes..... their member services staff are clueless......you can read my profile for many examples.In my situation with cigna, my question to member services did not have to do with the dieting requirement.I asked ten different people from member services about my particular question and I recieved 10 incorrect answers.This delayed my getting a surgery date for a year.I finally recieved the correct answer from a supervisor and now my surgery is scheduled for June 9th.Two of my friends are currently going through cigna to have their surgeries done and they have both recently been denied because they didn't have the 6 month diet requirement.One of them who lives in Arizona had even called cigna and asked about the diet requirement.The person at member services that she spoke with didn't mention anything about the diet requirement being increased to 6 months so she thought that she would be fine.She filed a grievance based on the fact that member services didn't divulge the info about the 6 month diet requirement and they still denied her based on not having the 6 month diet requirement.So unless you get very lucky and slip through the cracks ...cigna will use anything they can to deny you.
   — jennifer A.

May 12, 2003
I dealt with this very thing. They changed their criteria in November of 2002. When I first started this process, I called and was told it was based on medical necessity...they said nothing about diet attempts. When I got denied, it was because I didn't have 3 medically supervised weight loss attempts of 12 weeks each, the last one being in the last 12 months. After the required 3 months of dieting, I got another letter informing me that I was being denied again and that CIGNA was choosing to uphold their original denial based on the fact that I had not met their criteria of having attempted a weight loss program consisting of <b>2 separate diets lasting 26 weeks in duration.</b> I don't know what these people are thinking! You can read my "insurer" comments in my profile for the entire story. Good luck and don't give up!
   — Jeralyn Merideth