Question:
PCP doesn't know how to get me approved with Cigna HMO of AZ

I went to my PCP she said that she agrees that the surgery is a good idea, but she does not know what is required of her. She has given me a referral to Dr. Zahn and one to Dr. Blackstone so that I could choose who I wanted. She also referred me for a sleep test. What else does she need to do? I have Cigna HMO of Arizona.    — Brandyraj (posted on October 14, 2002)

October 13, 2002
Your surgeons office does the rest. He decides what tests you need and then you ask you pcp to refer you for each test. Most surgeons offices take care of the filing with the insurance co.
   — faybay

October 13, 2002
You may want to call CIGNA and find out their approval requirements for your coverage. Generally the surgeon's office takes care of getting approval, but with Cigna, it's wise to do your homework. Your PCP can help by getting together your records and writing a letter of medical necessity. If you have other doctors where your co-morbidities are documented, get those as well and as many letters of medical necessity as you can. I don't know what it's like with CIGNA in AZ, but here in VA, I had to have 12 weeks of physician supervised dieting. If you don't have that, get started now. Also make sure all your co-moribidities are documented in her notes because Cigna will want to see all of that for the approval process. It took me from January 2002 to May to get my approval. I had one denial because of the 12 week Physician Supervised diet, but it was approved after I appealed. I had my surgery 8/15/2002 and I can tell you post-op is the place to be!
   — Cathy S.

October 14, 2002
One thing you may want to consider, Dr.Blackstone is a Cigna approved surgeon for the wls, the other doctor is not. Dr.Blackston will have you go to her seminar, then compltete paper work. You mail in the paperwork, they will call you to set up a consultation. At that point, she will give you a list of tests to have done through your pcp. Dr.Blackstone will work on getting you approved through CIGNA. Your doctor can write you a letter of med nec to send along with Dr.Blackstone if you want, but her office will send the letter for approval to cigna. You do need to get your medical records together along with your weightloss attempts for the year. Hope this helps. You can email me if you need more info. Just an fyi, I sent in my paper work on Sept 19th and my consult date is set for Feb 13, 2003. But she has so much more going for her program than the other doctor that your pcp said she would send you to. good luck! :)
   — Tammy O.

October 15, 2002
I have CIGNA HMO in MA, and all my primary care had to do was refer me, and the surgeon I worked with took care of the rest. I had absolutely no problems. My suggestion is to talk to the two doctors and find out if they take care of it, and also try calling the CIGNA Customer Service. Best of Luck
   — Leslie A. J.