Question:
Does anyone know the qualifications for Cigna Health Care?

I don't know if it differs from state to state, but any info would be appreciated. I go to my PCP on Monday to get a referral and I want to be prepared. I was on Fen/Phen and WW, and Jenny Craig, and I have a few co-morbidies. Can someone tell me what the insurance will ask for?    — Carol E. (posted on November 16, 2001)

November 16, 2001
I have CIGNA HMO (Virginia) and when I asked about the surgery, this is what they told me: You have to be at least 100 pounds over weight. You have to have a BMI of 40 or greater OR 35 or greater WITH comorbidities. You have to have been obese for at least five years in a row, and you have to have been on a medically supervised diet within the last year. I met all these requirements except the medically supervised diet. I haven't been on one in several years, but that didn't prevent me from being approved for surgery. It took CIGNA about four weeks to approve me. It would have been sooner, but I didn't turn in any medical records with my request, so they had to request them from my doctor's office, which took extra time. Hope this helps.
   — Emily W.

November 19, 2001
I was approved within days by CIGNA (providence preffered) I have no co-morbidities but had my medical records showing I had been on Phen-phen, redux, etc. Good Luck!
   — Staci P.

March 31, 2002
Requirements for Cigna HMO: listed above but also add that three 3-month DOCTOR supervised weight loss plans must have been attempted-one within the last year. These include diet pills, being put on the American Heart Association or Diabetes diets. You must see the doctor EVERY month to be sure of this. I help with referrals for patients in my clinic, and this is an issue. If you can't prove it, you did not do it. The doc-in-a-box diet pill "clinics" where you pay in cash and they have pre-written and signed prescriptions for things like Phen-fen don't usually count since those were not documented in many cases. (Yes, there is a practicing doctor in my community with an office near mine that did that for a while. Horrifies me!) It is worth it to try though, you never know, some people are approved even without the stickiest of documentation. If you are on Cigna or Aetna though, be sure to avoid NeWeigh in Houston. We have referred 3 patients there from my clinic and I have been embarassed. They don't return my calls or calls from the patients. They are very sloppy and have outright lied to me concerning appeals. If you have United though, it is easy to get approval and they don't have to do much to earn their "kickback" from the surgeon. Unfortunately, two of the best docs in Houston exclusively use NeWeigh for their complete office work concerning insruance issues. For anyone seeking insurance information, call the office directly of at least THREE different surgeons and ask, they will be able to give you the most current answer. (I suggest 3 at least in case your first answer is intentionally misleading. I wasted 6 months on one of my patients with NeWeigh. Sigh.)
   — Emily P.

March 31, 2002
As you can see from the previous posts, it DOES differ from state to state. The only way to know what YOU have to provide is to get a copy of the policy from your employer. If you have a booklet your employer gave you with the insurance information, that may also have it. You can also call the customer service dept at the insurance, although you don't always get the correct answer if you do. Not only does it differ from one state to another, but some states (only a few) require that WLS be covered. Also, even the basic policy can be changed by your employer to include the surgery even if it isn't normally, or to exclude it if the policy would normally cover it.
   — garw

April 22, 2003
i have CGINA HMO. I had my surgery on 6/4/02. the only thing cigna requested was at least 5 years of medical records from my PCP. we submitted the medical history, a list of previous weight loss attempts and a letter from me. i rec'd my approval within 2 weeks (on the first try). i also just rec'd my approval from cigna for my tummy tuck as well. by the way i live in virginia, but i am pretty sure the procedure is somewhat similiar from state to state.
   — theresa M.

September 27, 2004
I have the requirements for a PPO for this surgery. If you'd like me to forward, I can email a PDF file to you. It is approximately 15 pages long. My email address, if you'd like a copy, please email me at [email protected]. Hope to hear from you.
   — Angel S.