Question:
I Have Cigna PPO. What are requirements for WLS approval?

   — lkworthy (posted on October 16, 2006)

October 16, 2006
I have CIGNA PPO as well. If you go to the website and type in bariatric as a keyword search, they have a position paper. They also have certified various weight loss clinics throughout the United States so check those out as well. One of the requirements is 6 months supervised weight loss. This is making monthly visits to your primary care or to the weight loss clinic that you are going to use and do the six months there. Since you have a PPO, you don't need PCP referreal to go to a bariatric clinic.
   — the7thdean

October 16, 2006
I had Cigna PPO when I had my surgery. It took 1 yr to get approved and that was after 1 denial. I had my Dr. (pcp) write a letter and all. I had everything they required, even a 10 diet history, but they sent me back to my pcp to be on a 6 mo supervised diet, so I went to my pcp and she just told me to come in once a month to weigh in and then she would resubmit my paperwork and within a week I got approved. Honestly, it took prayer that made it work. Just do what cigna requires and I feel like they will approve it. It make take some time, but believe me....... it's worth it!! I would have this surgery all over again if I had to! God bless!
   — teedegee

October 17, 2006
Hi LaTonya- I have Cigna PPO and I just had the surgery in August. I have to say they were kind of a nightmare I did receive two denials before I was finally approved with a conference call with Cigna. I do encourage you to challenge them and do not take no for an answer. It was about 9 months before I finally got approved. I needed a psych consult and a 6 month supervised weigthloss with my doctor. I visited him every month and he weighed me each time. Make sure your doctor makes good notes though, they challenged me about my 6 month program. Jenny Craig or Weight Watchers does not count, it must be medically supervised. Although it is difficult and almost everyone receives at least one denial with Cigna, please don't give up! It was well worth it and I finally got approved! I am feeling so much better!
   — tatybrown68

October 17, 2006
Hi. I also have CIGNA PPO as insurance. I had my surgery in April of this year, after a year and a half process. The 6 month medically supervised weight loss plan MUST be through your PCP, not your bariatric surgeon! After going to my surgeon for six months and doing the psych eval and nutritional counseling, I was denied because the weight loss plan CANNOT be done through a doctor who does weight loss surgery! I simply had to start over with my PCP, and after six more months I was approved within four days! CIGNA is good insurance, but you must follow their protocol. It would pay for you to call your CIGNA and ask them what is required, that way you will know exactly what is needed. Good luck, it is worth everything that you must go through to get it approved! I am down 84 pounds and feel wonderful! Karen
   — earthangel