Cigna requirements for California?

Could someone tell me what requirements Cigna has for someone who wants to get WLS (DS) in California?

Thanks!

You should call and talk to cigna them self. They would be best to tell you about YOUR coverage and requirements.

Best of luck

Luana

I agree that you should call your insurance to ask them directly.  (Plans vary widely.)  That's what I did.  And they even told me who the closest doctor they worked with was.

Best to get it straight from the horse's mouth!

 Have you tried looking up your policy online? If you can't find it then definitely give them a call. I don't know your BMI but if it's over 50 you should be okay. If they require a 6 month diet I have info on my page about that along with appeal info if you ever need it. Best of luck to you.

I have looked it up online.

But I was told some changes has been made recently to their policies.

I'm changing over from my PPO plan to the HMO plan. So I'm a little bit nervous about calling them before that happens. Incase they can deny me in any way if they know what I am planning.

I have started to do the 6 month supervised diet with my PCP, but also read the other day that I probably shouldn't do that becasue then they can claim that it is a pre exisiting condition? Any truth to that?

Is it true that I have to wait 3 months after switching to a new plan before I can send in my paper work?

And yes, my BMI is 52.5

Thanks!

 I don't see how they can consider it a pre-existing condition if you have continuous insurance coverage. It's not a plan that you bought on your own is it? If it's through your employer then all your medical stuff should just transfer. If it's a plan you buy on your own then WLS is excluded most, if not all the time. I would wait until you change over to the HMO plan, so you know which plan you have exactly, then you can find out what their criteria is. There are many HMO plans through the same company, so there's no way to know what your plan will be, until you switch over.

If you are already doing the supervised diet with your PCP then continue doing it. When your insurance switches over ask them to refer you to a bariatric surgeon then. You don't lose all your medical history/ records/ progress because you switch from one insurance to another. Your medical group may have a requirement on how long you need to do the supervised diet, etc.. but it's usually BS and you can just file a grievance with your insurance. I'm sure your IPA isn't going to want to pay for WLS for you when you are a new patient in their group.

You need to make sure that you get approved for WLS in general first, probably the RNY, once you get that approval then you go back to your PCP and ask for a referral for the DS.  You don't want to start off asking for the DS because your insurance/ medical group (because now you have a HMO) will find ways to put road blocks up for you. There usually is an in-network provider for you IPA/ insurance who does RNY so go through all the steps and make like a good patient and get RNY approval first. Please check out my page, there's a post there by Diana Cox that gives  you step by step instructions to getting the DS. 

Those on the DS board would be the ones to ask. They have some very knowledgable people on that board.  Cigna is starting to approve more and more for the DS, as before they were big on denials. Good luck.

Hi Karen!

How was your experience with Ara? I'm only wondering because he is the one I'm thinking about using as well.

Thanks!

Casper.

I'm not Karen & I haven't used Keshishian so you may not care about my opinion, but I'll give it anyway!

I've only had a consult with Dr.K, but in that hour and a half or so, I found him to be an amazing guy! I have Kaiser & if I win my IMR they choose who I go to. But, if I had my choice, I'd choose Dr.K. His patients LOVE him & he really seems to care about them. HTH!

Hi Danas!

I welcome all thought and opinions.

Thanks!