Question:
I Have Cigna PPO. What are requirements for WLS approval?
— lkworthy (posted on October 16, 2006)
October 16, 2006
I have CIGNA PPO as well. If you go to the website and type in bariatric
as a keyword search, they have a position paper. They also have certified
various weight loss clinics throughout the United States so check those out
as well. One of the requirements is 6 months supervised weight loss. This
is making monthly visits to your primary care or to the weight loss clinic
that you are going to use and do the six months there. Since you have a
PPO, you don't need PCP referreal to go to a bariatric clinic.
— the7thdean
October 16, 2006
I had Cigna PPO when I had my surgery. It took 1 yr to get approved and
that was after 1 denial. I had my Dr. (pcp) write a letter and all. I had
everything they required, even a 10 diet history, but they sent me back to
my pcp to be on a 6 mo supervised diet, so I went to my pcp and she just
told me to come in once a month to weigh in and then she would resubmit my
paperwork and within a week I got approved. Honestly, it took prayer that
made it work. Just do what cigna requires and I feel like they will approve
it. It make take some time, but believe me....... it's worth it!! I would
have this surgery all over again if I had to! God bless!
— teedegee
October 17, 2006
Hi LaTonya-
I have Cigna PPO and I just had the surgery in August. I have to say they
were kind of a nightmare I did receive two denials before I was finally
approved with a conference call with Cigna. I do encourage you to challenge
them and do not take no for an answer. It was about 9 months before I
finally got approved. I needed a psych consult and a 6 month supervised
weigthloss with my doctor. I visited him every month and he weighed me each
time. Make sure your doctor makes good notes though, they challenged me
about my 6 month program. Jenny Craig or Weight Watchers does not count,
it must be medically supervised. Although it is difficult and almost
everyone receives at least one denial with Cigna, please don't give up! It
was well worth it and I finally got approved! I am feeling so much better!
— tatybrown68
October 17, 2006
Hi. I also have CIGNA PPO as insurance. I had my surgery in April of this
year, after a year and a half process. The 6 month medically supervised
weight loss plan MUST be through your PCP, not your bariatric surgeon!
After going to my surgeon for six months and doing the psych eval and
nutritional counseling, I was denied because the weight loss plan CANNOT be
done through a doctor who does weight loss surgery! I simply had to start
over with my PCP, and after six more months I was approved within four
days! CIGNA is good insurance, but you must follow their protocol. It
would pay for you to call your CIGNA and ask them what is required, that
way you will know exactly what is needed. Good luck, it is worth
everything that you must go through to get it approved! I am down 84
pounds and feel wonderful!
Karen
— earthangel
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