Question:
Warning: Insurances Stiffen Requirements

Just want to warn the pre ops that Insurances are starting to deny more and more TRULY NEEDY WLS requests. My doc office staff had a meeting and they said that more and more are being denied. Please do your homework first. Get as much homework of "PROOF" so that you wont be denied. It is work but its so worth it... Just wanted to warn you they are tightening up and not approving as easy in the last few weeks. Well thats that Houston Dr.s are saying. Cigna is one thats tightening up!!!    — WLS_Deb (posted on July 28, 2003)

July 28, 2003
Blue Cross Blue Shield of Illinois is tightening up as well! I heard at our last support group meeting in Indianapolis that all the insurance companies are because more and more people are wanting it.
   — Michelle M.

July 28, 2003
When I went through the pre-approval process with Cigna, you had to have all the usual stuff they required plusl 3 12-week physician supervised weight loss attempts, one of which had to be in the last year. Now I've heard that they require 3 6-month physician supervised diet attempts, one of which must be in the last year. Their process is a bear to get through--must be horrible now.
   — Cathy S.

July 28, 2003
Cigna is the worst and when i called them before I started I was told nothing of the diets. though I showed 6 months on xenical since i did not have monthly weigh ins i was denied..on yahoo we have a group each trying to help the other with approvals, also when you call cigna you are told so many things that are not true or nothing they say your dr has to call....
   — jellyin

July 28, 2003
Cigna POS in ILL. is now requiring 2-26 week supervised diets one of which has to be in the past 12 months. I was just denied because of this. My husband will have open enrollment soon and I will be checking into switching insurance. I've had enough of dealing with a bunch of idiots who don't care about anyone.
   — Sherri M.

July 28, 2003
I have PCHS in Illinois. When I called & asked all about their approval process, they not only told me that I'd get approval, but that they had in fact approved for the same surgeion at the some hospital. Well, my papersork got messed up, and 6 months later, they TOO had tightened the requirements. The made my surgeon's office produce a atatistical analysis of every surgery by every doc with every complication. What a pain. But now that the office has created the report, any other patients whose insurance company requires this doesn't have to worry -- it's already done.
   — Annie H.

July 28, 2003
I just found out that my insurance company requires a 5 year history of some kind of diet/weight management program. I couldn't believe it. So, now I am trying to re-enact 5 years of dieting. This is the only thing holding up my surgery - they denied my approval because of it. (Great-West)
   — Dimple Donna

July 28, 2003
I heard that too from my surgeon at our support group meeting in Ma. Some insurance companies are asking for 3 or more years documentation of weight lose attemps. How crazy is that??? This was also discussed at the convention in Boston. We have to start fighting for the rights of others to have this surgery.
   — Kriola