Question:
Has anyone with Cigna HealthCare ever been approved for the gastric bypass surgery?

We have changed insurance companies, because of my husbands job. We now have Cigna HealthCare, which is a HMO policy. I called member services asking what their reguirements where for gastric bypass surgery and was told it was not covered with this policy. But, I've also been told by different people who have had this surgery, if it is medically needed they should approve it. Does anyone have this insurance and gotten approval? If so, what did you do to get approval? This is my third try for the surgery since 2002. I'm getting really disappointed and very upset about not being able to get this surgery, when it will help my health so many different ways. HELP...Michael P. Hocking M.D. Bariatrics    — Nancie Z. (posted on March 19, 2004)

March 19, 2004
yes they just keep changing the rules. I had UHC, same thing. Try www.obesitylawyers.com Good luck, don't stop the appeals.
   — superellen

March 19, 2004
your quote - "But, I've also been told by different people who have had this surgery, if it is medically needed they should approve it." My husband had Cigna POS and was denied even though Cigna said that it was medically necessary for him to have the surgery. They came back 6 months into his process and denied him saying that he did not have 2-26 week doctor supervised diet tries. He had a BMI over 60 with sleep apnea and high BP. Cigna is tough to get approval from as are other insurance companies lately even BCBS of IL. Fortunately, for us he was covered under my BCBS of IL PPO policy for open RNY and he had his surgery on 9/30/03. On 3/16 there was another member that posted a question about Cigna also, you might be interested in some of the answers. Good luck. Christine open RNY 5/7/03 241/156/130
   — ChristineB

March 19, 2004
Cigna is by far the most difficult ins. to deal with. I know that I was denied several times. They change the requirements at will. AS for being helpful, they are not. Very evasive. My husbands employer didnot renew the policy to cover wls, so I am now a self pay, going to Little Rock. Good luck with your fight.
   — bubbleboo K.

March 19, 2004
I have Cigna PPO and was approved first try hugs Ruthie
   — ruthie

March 20, 2004
I had Cigna HMO and they approved me on the first try. My profile may give you more info, but I really don't have much more to add because the process was pretty smooth and I don't really remember much of it. Best of luck to you! Sincerely, Mary Beth
   — Beffy W.

March 24, 2004
I'll be 2 years post-op 4/05/04. I'm happy to say, have lost 177 lbs.& am very happy with it's results. To answer your question..if you haven't been approved by now.. I noticed, many told you they were approved the first time. None gave you any help on how they got their approval. I was one of those lucky, first time approvals. It took some time & researching but worth the effort. I tried to write down any/all diets aka weight loss plans, I've ever attempted. Gave them at least the approx. mos. & yrs. plus amount loss. Sometimes, how long I kept the weight off. Than the amt,I put back on. I got letters from Drs, even Weight Watchers. [I joined so many times, they knew me well] I totally think what did it for me, was the small 4x6 photo album, I sent along with all this info. I have 3 grown children. I went as far as enclosing pics. of myself standing next to each of them, in their Cap n' Gowns at their H.S. Graduations.[the Yr.is printed on the pic] It's true what they say, ''Pics don't lie.'' Get Busy & Get Creative... YOUR WORTH IT!!! GOOD LUCK !!!....Sue
   — Sue B.

March 24, 2004
Cigna has stopped paying for WLS in SOME states. First you need to find out if they pay in your state. If they do you will have to have 2 (two) 26 week supervised diet attempts. Cigna will count Weight Watchers, Jenny Craig,ect... as well as monthly or weekely weigh ins with your PCP. Next it helps if you have your medical records for at least 3 years (5 yrs is better)with a letter stating the surgery is medically necessary (listing your comorbs) and a referral from your PCP to see a surgeon. You WILL have to have a psychological eval, an eval from a nutritionist, an exercise consult, and a EKG. Even if you have all this in hand, CIGNA is famous for turning you down on the first try. But if you appeal they usually give in. Good luck to you and DONT GIVE UP!!!! ~Sidney~ Open RNY 10-23-02 down 140+ and below goal
   — Siddy I.