Question:
Is Cigna making it even harder to quality for bariatric surgery?
I am in the process of completing the 6 month requirement to visit a dietician/nutritionist for approval from Cigna PPO. I am in month 5, and during my recent visit to my nutritionist, she said that she heard a rumor that Cigna is making it more difficult to get approval for bariatric surgery, saying that they are considering it an "elective" surgery. Has anyone heard anything about this? I'm not sure if she was telling me this to break my spirit (she always tells me that she's not trying to talk me out of having the surgery, but, I think that she is...) or if it is really true. At any rate, if anyone out there knows anything, please let me know. — CHEYENNE B. (posted on January 12, 2005)
January 11, 2005
It always has been considered an elective surgery. Just because you get
approval doesn't mean you MUST have it. Sounds like she isn't a fan of
surgery. Just keep pushing ahead and set your sights on what you started
this for. If your insurance said they wanted a 6 month diet to approve
then there isn't a good reason to assume they will renig. Good Luck and I
hope you can have surgery soon.
— zoedogcbr
January 11, 2005
My insurance does not pay for elective surgeries, only those that are
consideed medically necessary, they did not consider my RNY to be elective.
Do not go by the comments of a dietician who disapproves of bariatric
surgery as to what you insurance will or will not cover. talk to the
insurance company directly. Go to a surgeon who is experienced in getting
approvals, and let his office help you thru the approval process. I went
thru Bariatric Treatment Centers, Now Barix clinics and they did every
thing for me, I did not hve to write any letters, or do any thing except
wait (im)patiently for approval which was very fast, within a few days of
my ins co recieving the paprework. I believe this was so fast because Barix
had their act together and did it right the first time. Good LUCK to
you!!!!
— **willow**
January 12, 2005
Cigna is making it more difficult - I recently got approval from Cigna and
had my surgery on December 30, 2004. I was told by Cigna that they would
not be covering the surgery in 2005, that it would be an exclusion on all
renewing policies unless the employer specifically wants to cover it. This
does not mean that you should just quit trying to get approval from Cigna.
It does mean that it will be more difficult and that you may need outside
legal assistance to gain approval. My husband is still in the process of
trying to get approval and we don't know what will happen but we are still
trying and will not give up. I would encourage you to please not give up
write your state and federal lawmakers, let them know that this is a very
important subject. If medicare is paying for this then insurance should
have to pay for it. Insurance companies pay for substance abuse
treatments. They provide treatment for all other illnesses. They should
cover this life saving surgery. We CAN NOT give in on this. We must all
fight the insurance industry on this.
— Debra Bearden
January 12, 2005
You can call Cigna today and ask them. Just ask if they cover gastric
bypass when it's medically necessary. Were you denied and given the letter
that tells you the diets are required? If so, you can present that letter
later and say, "See, you wrote me and said these are the requirements
and I've met them." Kimberly - 135lbs (down from 253lbs)
— Kimberly S.
January 12, 2005
I just had surgery on 1/6/05 and I am insured with CIGNA. They do have the
6 month medically supervised diet requirement and make SURE your doctor is
getting monthly updates and documentation. They tried to say that since
the nutritionist was doing the weigh-ins my program was not medically
supervised.
There was a very clear exclusion in my 2005 policy booklet that excluded
coverage for WLS at non network providers and that NO plastic surgery would
be covered no matter if medically needed or not.
Good luck
— lauren4372
January 12, 2005
It has always been my understanding that even if WLS is considered
medically necessary, it is still an elective surgery. This sort of thing
is just more double-talk from the insurance companies because they don't
want to pay out such a large expense to help improve your health. There
are 4 states that have legislation dealing with WLS. I live in one of them
(Virginia) and I have still known people in this state to have insurance
problems and the companies still try to tell their clients that this
surgery is NOT covered by our legislation. You just have to stand your
ground with them and check out what your legal options are to protect
yourself. You can find a lot of info about WLS legislation on
www.findlaw.com. Good luck to you and don't let them get you down.
Insurance companies have done this sort of thing to a lot of people who are
now post-op. You'll get there. They just hope you'll back down. Don't do
it!!!
— SnowWhiteDove459
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