Question:
6 month dietwith Cigna PPO
Has anyone been approved with CIGNA PPO...and what should be included in the 6 months diet documented by your PCP. For example my dr just documents that I'm on a 1,200 cal diet and that he recommends for me to excercise 30-60 min daily...does anyone know if this is ok??? — MeliG (posted on September 27, 2007)
September 27, 2007
I think you are to be on a monitored diet and nutrition plan for 6 months
by your DR. proving that you have exhausted any other means of the weight
coming off without surgery. Also I was required to lose 5% of my body
weight before they would approve my surgery to prove I was serious and knew
what I was getting myself into. Hope this helps.
— Shannon J.
September 27, 2007
I have SuperMed Select, but was also required to do the 6-month diet. My
doctor forgot to put in each month's notes -- weight, type of diet and
exercise. Prior to submitting to the insurance co, the surgeon's office
asked for a letter from my PCP stating that I had been on a 6-month low cal
diet along with walking. I am waiting insurance approval. The only other
think that the ins co asked for after my documents were submitted was a
cardiac clearance, which I just happened to receive the same night. Best
of luck to you.
— dthomp
September 27, 2007
Hi, I dont have Cigna but NH Medicaid requires 6mo supervised diet with my
pcp. She documented my weight and height on first visit and then documented
my weight at each of the other 6 visits. She also stated that we spent at
least 50% of each visit discussing diet and exercise. I was told by the
surgeon that it was these were very important things to list because if
even 1 visit didnt record my weight and the time spent discussing diet and
exercise, it would be denied as an eligible visit. I am now just waiting
for my approval. good luck to you
Jan E
— jayme1943
September 27, 2007
Hello Melisa,
I have CIGNA PPO and my PCP put me on an appetite suppressant called
Phendremine (probably misspelled it) --it's not Phen-Phen. It's an old
suppressant that has been around since the 50's. I went in an weighed each
month, got my new prescription and it most definitely curbs your appetite.
I found myself eating more veggies, less french fries and breads, no sodas.
Just since you weigh in once a month -- you'll be okay. She didn't place
me on any kind of nutrition program, I still pretty much ate what I wanted
just not as much. I lost 20 pounds the six months I was on it -- I think
the challenge is NOT to gain weight while on supervised plan. Whatever the
PCP documents the insurance company is not going to argue with. Good
Luck, let us know how you're doing
— the7thdean
September 27, 2007
I AM ALSO ON CIGNA PPO. I HAVE NOT TURNED IN THE INFO. I AM ALMOST 6 MONTHS
FROM MY PCP. I WAS TOLD I NEEDED A PHSC AVAL,1 NUTRUTION VISIT,6 MONTHS
FROM MY PCP. MY DOC SAYS HE FEELS IT SHOULD BE COVERED.
GOOD LUCK!
— JACKIESMOM
September 28, 2007
Like some of the others said, be sure and have dr document your weight each
month, what he recommended to you about diet and exercise or he could have
you visit a nutritionist each month. I just went in each month and got
weighed, what my dr thought they needed and it wasn't enough. Some proof of
diet and exercise. I wasted 6 mos.
— geneswife
September 28, 2007
I have Cigna ppo and had a nitemare trying to get approved. They denied me
twice, but I finally won! They wanted everything documented and worded just
right. I submitted 6 months of dr. assisted weight loss attempts. On each
month posting it had to include weight, blood pressure, pulse, and what
discussion took place about positive reassurance. I also provided 4 yrs rx
info. proving my weight loss meds tried. I had a document showing I had
sleep apnea, fibromyalgia, asthma, and GERD which all would improve with
weight loss. I had letters from 3 different Dr.'s and they finally
approved it after I had a teleconference with 4 people. Just don't give
up. My Dr.said they deny you because they are doing their job.. our job
needs to be...being stubborn!!! Good luck!
— Terrijean
September 30, 2007
I ALSO HAVE CIGNA PPO, I HAVEN'T SUBMITTED EVERYTHING TO THE INSURENCE YET
BUT I WAS TOLD THAT I NEEDED 6 MONTHS OF DR'S NOTES,WEIGHT,BMI,NOTEA ABOUT
DIET AND EXERCISE. I WAS TOLD I NEEDED 1 NUTRITIONIST APPT AND PHSC
EVAL.PLUS MY LETTER OF NECESITY. I AM HOPING THIS IS ALL ENOUGH BUT I WILL
APPEAL IF NEEDED,I JUST DON'T WANT TO HAVE TO START ALLL OVER. GOOD LUCK TO
YOU!
ERICA
— JACKIESMOM
October 1, 2007
I had nothing but problems with CIGNA PPO-- the height of their zeal to
avoid paying was when they declared that my pre-approval was for the
hospitalization but not the surgery. They then requested the same
materials (mostly the diet history and some medical records) several times
(even after my surgeon's nurse faxed them the signed receipts from the
prior shipments of those items.
My advice with CIGNA is to know that they will be dishonest- so get the
name of every person with whom you speak and try to get as much in writing
as is possible. Also, file complains with your state insurance commission
as soon as they breach their agreements with you.
— SteveColarossi
October 9, 2007
Hi! I HAVE Cigna PPO. I believe it depends on what state your approval is
coming from. I knew when I got started what qualifications they wanted
satisfied. The time it took to do it was all on me. I did the six month
diet with my PCP. Each month I went in, she weight me, took BP and pulse,
and we discussed how I did and what I could do. I only lost 18 pounds
during this time. But by the time I finished, I had my psych eval and
Nutrition eval done, plus a heart clearance. When my surgeon office turned
in all my paper work, I almost had a heart attack when they called me one
and a half week latter to say Congratulations! You have been approved. The
process went too smooth. Cigna even followed up a week and a half latter
with a personal case worker that gave me her direct line to reach her if I
have any questions or problems. They were very nice and I could not believe
her patience on the phone, she even chatted for a few minutes. No problems
so far. My surgeons office got their approval direct as did the Hospital.
I'm exactly two weeks away. I'm starting to get nervous now. Hopefully you
will get a quick approval also. You can let me know if you want.
— icepurple
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