Cigna insurance question (kinda long)

Hope someone has something that will ease my mind. I have Cigna insurance through the State of Illinois. I started the doctor supervised weight management last October. I had a knee surgery in December so I accidentally missed January and I voluntarily started again in February. This month will be the last month of the six months.  I asked Cigna several times for a list of requirements. They said it was on-line but I couldn't find it (turns out it was hidden in the doctor's section of the website--the one place I DIDN'T look.) My surgeon submitted to the insurance (which was denied) in November and I talked to an insurance representative at the time. She said I needed to have documented proof of weight loss program (diabetic diet - I saw the local dietician as well as my doctor), calorie intake, physical activity or lack (with reasoning), behavioral management (seeing a counselor), consideration of drug therapy (considered it but opted not to pursue it).  Here's the problem. I interpreted calorie intake as the amount of calories I should be eating so I didn't think much more about it. In April, after reading a post on the main forum, I started thinking they meant food diaries...which I don't have. I have kept them since April so I have some proof but my doctor didn't require them. My doctor kept a record of my weight, BP, etc. but not calories. While she is helpful and supportive of the surgery, she is depending on me to tell her what to put in the records adn do all the footwork and interpretation. I gave her the denial letter with the requirements in it and obviously she didn't read it as requiring a food diary either (assuming she actually read it). I haven't lost much weight and my weight fluctuates by up to 5 pounds a month because of edema.  So tell me, am I in trouble? Am I going to have to start again? I really will be ticked off if I have to start over because the fall is the best time for me to be away from work for 2-3 weeks. Spring is much busier in my office and will be more difficult on everyone if I'm away. AND I'M TIRED OF WAITING! I'm really ready to move on with my life and it feels like I've been treading water for 9 months.  Any insights?

I would interpet calorie intake to mean the amount of calories  being eaten. I would think a food diary/ food log would be be different.  I don't have Cigna, so I don't know what they require.  I did my 6 month supervised diet thru Dr. Joyce's office.  I never went to my pcp for anything except my records. Hope this helps!

I have Cigna through the state of IL also and they didn't require a food diary. I don't even think they wanted the calories by number. My doc said I was following the South Beach and counting calories. They want the actual case notes. The doc's letter was ignored. Each note needs to say the weight loss program, phys. activity, behavioral mgmt and drug therapy or not. And as you found out, you have to be there each month. You should be accepted with this. I had my surgery last Oct and my partner who is on my insurance had surgery in Nov. 

Good luck!

Connie 

Thanks for your answers. I have no idea what her notes actually say. We talked about it but we didn't always talk about specific numbers of calories. I'll just have to wait and see what happens. Cigna is in control (at the moment).   Connie, your new pic looks great. I'm so anxious to get going on a new, healthier me.

I have State of Illinois Cigna as well.  I ended up having to do the 6 month diet twice because my doctor did not document my records enough.  The second time around, at each visit, he recorded my weight, what I was eating/my dieting attempts, and my exercise/workout for the month.  I provided him with a chart to fill out to write this information up when my 6 month diet was done.  He also summarized my 5 year medical history along with supporting information as to why I needed this surgery ie: co morbidities.  It was approved on the second round.  The first round was submitted without all of my pcp information.  I know it is frustrating to have to start all over.  It doesn't hurt to call and ask.  Document who you talked to.  But when I appealed, I only had so many days (I think it was 60) for approval.  It actually took me 2 years from the time I went to my first seminar to my surgery.  It just made me really ready to have surgery and very sure of my decision!  Good luck! 

For your knowledge--I just had a run in with Cigna. My doc suggested an MRI and now they won't pay because they said it had to be preapproved and wasn't. However, the MRI showed a problem and now I will have to protest the denial but not until after the bill comes. What a mess. The woman told me that any outpatient visit for ANYTHING is supposed to be preapproved. That is ridiculous! I said, "even a doctor's appointment?" and she said, "if the doctor does anything, yes". Well, DUH! Of course the doctor will DO something--why else would you go--to have a chat? Can you tell I'm annoyed. Since you all will be dealing with Cigna I thought you should hear this.

Connie