Question:
Denied by Cigna because I didn't have a supervised diet... Help please!!

I called Cigna to find out the status of my request for open RNY and they said I was denied because I didn't have a 6 month supervised diet. After being frustrated at that answer because I meet every other requirement I spoke with a supervisor and I asked her "am I right when I say that Cigna won't pay for anything weight related?" She said yes. I said "so each time I go to my doctor regarding my weight (supervised diet) I am paying everything out of pocket because Cigna won't cover right, including any diet pills she might put me on?" She said that's right. Now tell me how can they require a supervised diet for 6MONTHS when they won't cover a cent of it? Can this be fought? This just doesn't seem right. Thank you for any help or advice you can give. I am so upset.    — Sherri M. (posted on July 11, 2003)


July 11, 2003
CIGNA is a big pain in the ass! Not only will they give you the run around about recieving your information ( My Dr.'s office had to threaten to send it certified mail because they kept saying they didn't recieve things faxed several times) They will also try to deny everything. Each person you talk to will tell you something slightly different about the requirements. I was told at first that the supervised diet had to be 26 weeks long and with in the last 2 years. Then I was told it had to be 12 - 24 months long and with in the last year. I have PPo and their aprovals go through intercorp and if that is your case see if you can talk directly to the review nurse there. When you go through the automated system punch in that you are a physician. ( you can always tell them that was a mistake when they find out that you are the patient) The review nurse was most helpful - I was going to be denied and was finally approved 1 week after talking to her. If you have any other physical problems that the doctor can recomend you be on a diet for to help alieviate then they will pay because you are seeing him for something like joint pain, sleep disorders or diabetes. Then when there explain to the doctor that you need the supervised weight loss and you need to have regular apointments to monitor the progress. The progress of the "joint pain" will be the official reason you are there but at the same time your weight will be documented. Some doctors will allow you to come in with out an appointment just to get weighed and have your weekly or bi weekly weight documented in the chart until the next appointment. Try this and e-mail me if you need some support. Good luck - Diane Koch
   — dianekoch

July 11, 2003
I am waiting for an approval from Cigna since May 2!! They lost fmy file twice and just this week alone told my drs office my file was again missing tests! And of course my drs office had faxed it to the correct #. They are unbelievable and I am so frustrated because I have a hernia which dr said is weight related and it's bothering me whenever my daughter lays on me! Any further info on Cigna let's email for support and help!! Mary Meer
   — mary M.

July 11, 2003
Hi, I am the original poster of this question and just wanted to let you know after I posted this question I checked my mail and the letter from the review board was there and it said they require two 26 week supervised diets. Nice huh? Different requirements everytime I talk to someone. I am thinking I should look a different insurance because this is just crazy.Not to mention that I have run into some not so nice people in my dealings with them.
   — Sherri M.

July 11, 2003
I knew Cigna was about to change their guide lines, but didn't know the change was so steep. When I first went for my surgeon consult in January 2002, he warned me about this. At the time Cigna required 3 12-week physician supervised diets, one of which had to be in the last year. I went to my physician the same week and got started. I was denied in late March of 2002, but my 12 weeks was up the first week in April. I wrote a very passionate letter and submitted my doctor's notes regarding the 12 weeks and got approval in late May. I have my surgery in August 2002 and am down 150 lbs, plus the 41 I lost while I was waiting. My best advice to you with Cigna is get to your regular doctor and get started today. Document your meals every day and get weighed at least monthly. My doctor gave me a 1600 calorie a day diet and weighed me monthly. I had other co-morbidities that it gave us the excuse to document during this time, so it only strengthened my case. Good Luck. Cigna is a hard nut to crack.
   — Cathy S.

July 11, 2003
Hi Sherri, I can feel your pain! I was also denied for the same reason just two weeks ago! The thing that scares me is no matter how many hoops we jump through, they will still find a reason to deny us... If you look a little further down the list of questions you will see a question posted where that just happened. She appealed with the info they wanted then they found another reason to deny the funds.. You and I both know that the bottom line here is the almighty dollar and not the health of it's members at all.. And after doing further research and talking to my HR dept. I've come to the conclusion that they aren't going to budge unless we can bring in a little muscle.. I submitted everything I could get the first time around they still denied me and I compiled info and diet documents for months before my surgeon submitted. And NO there is no exclusion in my policy. Soooo guess I'll be calling Mr. Lindstrom to bring in the muscle. Whatever you decide don't take no for an answer. We must fight, after all, this is OUR health and life we are talking about. And we pay those premiums to have that healthcare when we need it.. If you would like to talk feel free to email me at [email protected] May God Bless you on your journey. Vikki
   — Vikki L.

July 11, 2003
I was denied by Cigna PPO for the same reason. I did have weight watchers documentation. One was for 13 weeks and then a three month break and then I have proof of another 17 weeks. My surgeon appealed and I found out today I won the appeal. My advise is to have your surgeon, primary and any Dr that you can write a letter to appeal. You should do a letter also. Make it very compassionate, include pictures of your children if you have them. Make them feel horrible that you were denied. Good Luck
   — shbama

July 12, 2003
Cigna just denied me and I had the two 26 weeks of WW. I agree with everything that has been posted about them. They are horrible to deal with and everyone, including a supervisor(if he really was one) did not know what they were talking about. I am going to call a lawyer.
   — Karen T.

July 12, 2003
Yesterday my bubble was burst. Cigna is upholding their denial and requirements for another 6 month failed diet attempt and an "exercise person's" review. This now means I won't be able to do anything until at least January. Who knows what they will require then. Besides that my boss (a doctor) told me yesterday in my review that my "personal thing" meaning my surgery - how could they do without me during my recovery. I immediately told him that we would of course get a temporary for the two-three weeks I would be out. He's all for me losing weight, encourages me to continue working out at Curves at lunch and dieting since he's sure that's how I will lose my weight. What the hell do I do - by December I could lose 30# possibly and go below my BMI and weight requirements for surgery and get denied for being below the 100#/BMI requirements. You all know how it is, you stop any part of it and it goes right back up. I am in such a funk. Thank God for anti-depressants or I would be manic right now.
   — Sunie I.

July 12, 2003
My advice would be to switch insurances if you are able. Cigna, as all have said, is horrible to deal with! They get worse by the minute. I work for a surgeon in Massachusetts and I can attest to the stunts. Either change insurances or as the other poster said, bring in some muscle. See an attorney if you are able to see if you have a case.
   — KARENMAC




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