Cigna HRA Insurance Requirements

Hello,

I'm so frustrated to the point where I can do nothing but hide and cry. I want to lose weight so bad and I have done everything you can imagine. I have Cigna HRA through my job and they will cover the VSG, however what is frustrating me so bad is that I don't understand the policy itself. I called Cigna and was advised to look at the coverage on line **blank-stare**. If there is anyone out there can tell me what they had to go through step by step just so that I can have some understanding for myself. I'm so tired of crying I just want to be happy with my self and my appearance, pretty depressing when I went to my son school and he wanted people to think I was his aunt cause he was so ashamed of me. What I don't understand is the 12 months part, I seen some forums that said that they only require 6 months diet program supervised. Will I have to wait a year with 3 months consecutive being seen by the Dr. or this is just what Cigna tells you.

Cigna on line policy:

 

Medical management including evidence of active participation within the last 12 months in a weight-management program that is supervised either by a physician or a registered dietician for a minimum of three consecutive months. The weight-management program must include monthly documentation of

ALL of the following components:



weight



current dietary program



Programs such as Weigh****chers

physical activity (e.g., exercise program) ®, Jenny Craig® and Optifast® are acceptable alternatives if done in conjunction with the supervision of a physician or registered dietician and detailed documentation of participation is available for review. However, physician-supervised programs consisting exclusively of pharmacological management are not sufficient to meet this requirement.

it sounds to me like you have to do a 3 month supervised diet with your doctor. Your doctor's office will know what they need and will help direct you.

What confuses me is where they talk about 12 month medical management. Would I've had to be managed by a Dr for 12 months then do the 3 months consecutively of the weight, dietary program and exercise...

I believe it is saying you had to participate in the 3 month doc supervised within the past 12 months. So if you did it two years ago it wouldn't count. That is how I read it anyway.

I always hated the part of the job where I had to deal with insurance companies. What they are saying is that within the last 12 months that you had to have had a physcian supervised weight loss program for 3 consecutive months documenting weight, diet type and type of exercise.
Hope this helps.
Christy

Ok thanks, for that info... I guess what I was thinking that I had to see an Dr. who would have documented my weight. I haven't been to the Dr. since 2010, so that's why I was confused. I just got a new PCP who would not have had a record with anythkng in me in the last 12 months. I have gone to an seminar and have been wanting to have weight loss surgery for about 2 years now. Just wanting it so bad, ready for this life time commitment..

I forgot to add I just went to the Dr last week to talk about my weight. So can it be 3 consecutive months from July - Oct 2012, or like 2013. Sorry if I'm asking what you may think to be crazy questions I just don't understand.

typically when you see the weight loss surgeon his/her office knows what the insurance requires and will help you to accomplish the necessary requirements. Call the office and check with them.

If the doctor documented your weight at that visit and if you discussed yoru diet with him/her and he/she documented that, then it would count, yes.

Yes that is correct. So is you went last week then you need to go August and September for diet, weight, and exercise documentation, then they can put in for approval for your surgery.
Christy