Question:
Has anyone been approved since March 1 2003 without a supervised diet with Cigna PPO?
My husband has been denied coverage because he hasn't been on a 6 months diet under the dr. supervision. They just changed the critera in March. Didn't mention it in Feb. when we called. Rumor has it they aren't going to cover this surgery at all by the end of the summer, so is this a stall? My denial letter will probably be here next week. — Mary G. (posted on June 20, 2003)
June 20, 2003
Hi, I was approved in mid-May in CT for lap RNY. I have about 120lbs to
lose and never had a medically supervised diet but did list all other diets
I had tried, including weight watchers and fad diets. I didn't hear
anything about them not covering it in the future. My surgeons office
submitted all the info. I was worried about not getting approval and was
told not to worry because they had never been denied by cigna. My office
does know what each insurance company is looking for though.
— Heather S.
June 20, 2003
Hi, I am sorry. I know how disappointing that is. I just received a call
yesterday also telling me that I was denied as well from Cigna PPO for the
same reason. I am going to see my doctor to see how much information has
been recorded of my diet attempts. If there isn't enough I don't know what
I am going to do. I just know that it is terribly heart breaking.
— Happy Girl
June 20, 2003
Today I found out that I, too, was denied due to lack of a medically
supervised diet lasting longer than 26 weeks in the past 12-24 months. I
did sumbit a significant amount of diet and exercise history. It was not
disclosed to me as a requirement when I spoke with Cigna PPO in Dec-02. It
was recommended that my surgeons office's PA call the peer-to-peer review
line to discuss the denial and start the appeal process. The RN for the
Cigna PPO clinical department (outsourced and based in Pittsburg) stated
that it could be something as simple as a clarification. During my
discussion with the RN I was lead to believe that denial is the first step
in a Cigna approval. I am determined to have this surgery, scheduled for
3-Sept. It might just take a ton of phone calls and letters. I will find
our more next week. Good luck!
— Jennifer M.
June 21, 2003
I have had nothing but trouble with my CIGNA PPO-- it took an insurance
consultant, my own threats (I'm an attorney) and my wife's employer calling
them before they finally decided to honor their obligation to pay for the
surgery. Even after they agreed to pay for the surgery (they intially said
that they had only approved my "hospitalization" and not the
actual surgery), they then held up payment alleging that my surgeon wasn't
"in their system" (even though they had already made payment to
him for some of my office visits). I found CIGNA to be blatantly dishonest
in all of my dealings with them.
My best advice to review your enrollment contracts very carefully and see
what conditions were put on WLS and what CIGNA reserved for their right to
change the plan's conditions.
— SteveColarossi
June 24, 2003
I too have been thru this process and am now in my second appeal and have a
peer to peer mediation in the works, They initially didn't tell me either
about the supervised diets for 26 weeks in the last year, I started
immediately to go to my doctor weekly for weigh ins, and he put me on a
1200 calorie diet, logging in my weight each time. By the time I turned in
my second appeal I had 2 months completed and I am still working on it.
they have stalled me for months, just hang in there and keep fighting, the
more noise you make the more responsive they seem to be...sheila
— sheila F.
Click Here to Return