Question:
Cigna PPO/Open Access-6 month diet
Cigna is requiring me to have a 6 month diet. My question is that they want chart notes and I work for several doctors and they would prescribe me or counsel me on diet and exercise but never had any chart notes. I have two of them writing a letter for me. Do you know if this will work? If you have had this or know anything that will help please let me know. I am starting a letter of my own for all my attempts for the last 20 years. Any advise would be great!! — RobinH (posted on December 29, 2005)
December 29, 2005
HI, I had to have a year of supervised weight loss for BCBS PPO, and
basically what they were looking for were 12 months of me being weighed in
and charted.. I only had 10, but they took it anyway.. I had surgery on
Nov 1st, and BCBS has already paid my bill!! Good luck!!
— April
December 29, 2005
Hello Robin,
We are in the same boat. I don't know if they will accept that or not, but
time will tell. My doctor put me on an appetite suppressant called
phentermine -- this stuff is approved by the FDA and regulated by DEA --
and can only be used for 30 days. I thought I was going crazy until I read
the side effects. If you can remember any physicians that you ever went
too and kept record regarding your weight loss efforts, get them to write
too. I haven't started to seek approval. I chose the clinic at Sinai in
Baltimore MD and they told me CIGNA required a 6 mth process and to contact
them at 4 mths and do not miss a month with the doctor because if you do
you have to start all over again. Have you chosen a surgeon yet?
— the7thdean
December 29, 2005
I also had BCBS. They required 12 month dr. documented diet history. Like
you, I had been counseled on different diets & exercise, but it was not
noted in the chart notes. I had both a primary & secondary insurance.
BCBS of Illinois disapproved my surgery because of this, but BCBS of Texas,
which has the same criteria, approved it. Each insurance is different. I
got letters from my various physicians and added one of my own too. I also
sent in copies of my primary physicians notes each time I was in to see
him. They weigh you everytime you go in so at least that was there to show
the up & down of the weight through the years. I'd say send in the
letters with what you have & see what they do. Good luck!
Diana C. 234/165
— Diana C.
December 29, 2005
hello
I had cigna and had to have 6 months dr. supervised diet with journal of
everything I ate for that period. I got copies of my medical records to
show that I saw my dr. every month to dicuss and bring in my journal for
the month. I had a letter from my surgeon and primary care physician. I
had 67 pages of documnetation and sent it in and was denied. Go figure. I
hired a lady to do my appeal letter and she really helped me have
everything organized with pictures of me and everything in order. two weeks
after I sent all this in again with the appeal letter I was approved.
Cigna is tough. They make you jump through hoops but it was worth it. I
am not 13 months post op and 105 pounds lighter. Good Luck. email me if
you have any questions.
— taterbug898
December 29, 2005
I too had Cigna. The diet was for 6 months with monthly trips to the
dietician with food logs, weight and chart notes. Each individual
considers chart notes for certain things and Cigna does not specify exactly
what chart notes are, so continue to get the letters from the doctors and
any other documentation that you have for weight loss attempts whether it
be Nutri-system, Jenny Craig, Weight Watchers, etc. I was denied for the
first submittal and then decided I could lose the weight myself, did not
happen. Then I went through the whole process and they stated I was 2
weeks short of six months. I was working with Barix Clinics and they sent
all of my documentation to an attorney for an appeal. When this happened I
sent all of my previous documentation from the first time and the diet
attempts. I was again denied but the reasons for the denial were changing.
At the final appeal level with an arbitrator it was approved. It took 6
months longer than ususal but the documentation is what saved me. I
immediately got the approval code and scheduled surgery for 2 weeks later.
It was the best thing I did because it really gave me time to think and
decide if this was what I really wanted to do. Cigna will make you jump
through hoops but if you save all documentation you will be fine when it
comes appeal time. Walter and Kelly Lindstrom of Obesity Law and Advocacy
Center in California (I live in Illinois) handled the appeal and I kept me
up to date and assured me things would come out all right and bless his
heart they did. Stick with it and things will work out fine.
— 1968 Loser
December 29, 2005
Hi, I had Cigna PPO and was denied twice even after my doctor sent them a
years worth of chart notes, weigh-ins etc. Finally he told me..."I
just don't know what the hell they want from me, I'm being as specific as
possible..giving them the diagnosis, dates I treated you, your weight, the
treatment (medication, counseling etc.) and the outcome (success/failure
rate) and it's not good enough." Finally my doctor got irritated
enough with the company Cigna hires to make these determinations that he
called them directly and asked to speak to the head doc. on their medical
review board. After a 15 min. discussion with him about how this surgery
is a necessity for my co-morbidities I was approved in no time. I don't
think I have any of my paperwork anymore since I've moved but the bottom
line is...we gave them what they wanted and it kept getting denied (rather
quickly too) because they were saying it wasn't specific enough..and I had
well over a year charted! Depending on how severe your health is now and
how necessary this surgery is for you (I was in a wheelchair on disability
at the time and it was a life/death situation for me-not voluntary by any
means) You may want to see if your doc can give them a call after all other
attempts fail. Good Luck!
— boonikki29
December 30, 2005
Hi Robin, I also have Cigna PPO and have been denied twice since I started
this process 2 years ago, this last year I have basically given up, but
vowed to myself come January I will start again and try and give Cigna the
documentation they are seeking, maybe we can keep in contact with each
other and help each other along the way. Its very frustrating but I know
for my heath's sake I need to stay focused.
— [Deactivated Member]
December 31, 2005
Cigna wants BMI, documentation of a complete multidisplinary team
assessment with access to psychiatric and nutritional expertise; and
documentation submitted of active participation and reasonable compliance
with a dr supervised weight loss program for a minimum of 26 CONSECUTIVE
weeks in the past 5 years. Program should include weigh-ins at least
monthly, low calorie diet, behavioral modification and exercise.
This was on a denial I received. Must include all these things. All
documented. Its a bunch of crap. I told my husband if I died from
comorbidities to sue the insurance company. My doctor just did not know
what info the insurance wanted.
— geneswife
January 4, 2006
I have Cigna PPO also and was denied at first attempt. I had my
gastroentologist and my surgeon both write letters stating that I needed
the surgery, my regular MD also. I also sent a letter in detailing how
much I am suffering from all my ailments and basically told them that if I
was not approved, I would seek the counsel of an attorney skilled in these
matters. That seemed to do the trick! The set up a telephone conference
with my surgeon. I was approved immediately after the call.
They keep stalling just hoping you will give up and pay for it yourself.
You need more than one doctor's opinion, I believe. The fact that I had
three doctor's all stating that i needed a resection to RNY is what made
the difference. Plus I think that stating I would seek legal counsel
probably did not hurt! ; )
Good luck!
— arcadiaden
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