Question:
Dr. supervised diet needed for 26 weeks prior to surgery for CIGNA approval
CIGNA requires 2 diet attempts of at least 26 weeks each, with 1 being in the 12 months prior to surgery. My PCP referred me to a nutritian, but Cigna won't cover it. I asked for a low-cal diet from a PA today at my Dr.'s office - figuring I could weigh in with them. She suggested I join weight watchers (AGAIN?!?) Has anyone else been through this? I have PLENTY of WL history, just nothing in the last 12 months. SUGGESTIONS?!? Thank you SO much! — Susan B. (posted on July 15, 2003)
July 15, 2003
Your PCP doesn't sound WLS friendly, you msy want to ask your surgeon to
recommend a WLS friendly PCP that they have worked with in the past.
On the diet front, you may want to ask a PCP to prescribe one of the newer
diet drugs, like Meridia, or Xenical, make an appointment with the PCP at
least monthly to weigh in and have them follow your progress. The clincal
notes to your record at the PCP will be essential to proving that you were
on a physician supervised diet, you may also get a copy of your records
from your pharmacy to prove that you used the prescription for the required
number of weeks. Good luck.
— David F.
July 15, 2003
Well, thats strange...mine was covered by Cinga on the spot. I handed them
my card, and debit card, and VOILA! Of course, I saw a CIGNA dietician,
too. Don't you have any CIGNA dieticians there, or at another glorious
CIGNA site? I only paid my normal co-pay of $15.00, I believe, but I KNOW
if didn't exceed $25.00. She put me on an 1800 calorie diet. (basically a
diabetic diet). Read my profile, or e-mail me if I can help you. I'd be
glad to help you if I can.
— [Deactivated Member]
July 15, 2003
please spend the money to see the nutrionalist..I learned from mine DIETS
do not work..She helped me to put together a new way of eating that was
marvelous..I lost 38 pounds and i weighed in with her once a month..it was
worth the money...I will continue to see her post op..
— Kathy S.
July 15, 2003
Many Registered Licensed Dieticians are covered by insurance carriers, but
many Nutritionists are not. See if your insurance differentiates the 2.
— M B.
July 15, 2003
For a doctor supervised diet all you need to do is tell your doc that you
are dieting and exercising and have your doc document that.Then you go in
once a month to get weighed.
— jennifer A.
July 15, 2003
I'm currently having the same problems. My medical "group"
requires the medically supervised weight loss as well as being on Meridia
and Xenical. On this sight I asked about those drugs and they had a lot of
bad feed back...such as Meridia just doesn't work and Xenical keeps you
running to the restroom. I don't know about you but I don't want to be on
the toilet all day, especially while at work :( I deceided to change my
medical "group" to one that doesn't have those requirements. I
think it's really funny that the group can have a whole separate set of
guide lines from the actual insurance carrier. Good luck!
— April R.
July 15, 2003
I have Cigna HMO. I was weighed at my doctors office every 3 months and my
PCP kept notes in my chart about my diet progress or lack of. Cigna denied
my for not having WEEKLY weigh-ins, they said that once a month is not
"supervised". After I did Weight Watchers for 12 weeks I was
accepted. They have changed it to 26 weeks now. :( The best thing I can
tell you is join WW or Jenny Craig NOW for 26 weeks or go to your PCP's
office EVERY WEEK and have your weight put in your chart. Cinga will not
bend on these ruls but they will pay if you prove your 26 weeks weekly
weigh ins. Sorry you may have to wait a while longer but dont give up, its
worth it. Also my PCP put it in my chart(as well in her letter to Cigna)
that she did not put me on diet drugs do to possible reactions to my meds I
was on at the time and Cigna waved that. Good luck to you. ~Sidney~ OPen
RNY 10-23-02 down 100+ and counting
— Siddy I.
July 16, 2003
I have cigna and I'm in Arizona....They wouldn't have accepted weighing in
every 3 months but they did accept a monthly weigh in as a supervised
diet.Looks like the cigna's are not consistent with their policies but that
is not a big surprise. =)
— jennifer A.
July 16, 2003
Susan, be real careful about trying the "weight loss" drugs.
Aside from the obvious nasty side effects, per my denial letter (and I
quote): PRESCRIPTION OF WEIGHT LOSS DRUGS IS CONSIDERED AN ADJUNCT TO OTHER
MEASURES AND DOES NOT BY ITSELF CONSITUTE AN ADEQUATE PROGRAM)I myself have
not used them, nor would I. I just do not have the interst in trying them.
(Personal opinion only)
— [Deactivated Member]
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