"We have never had a Cigna patient approved????"

Ok, I cannot believe it.  I went to the one on one with my surgeon yesterday and everything seemed to be goign fine.  I have my 6 month diet done and all of my specialists done and the paperwork looks great!  EXCEPT....the surgeon looks at what type of insurance i have and sees Cigna and changes his tune.  All of a sudden they have never had a Cigna patient that was approved.   Thankfully Paul here on OH has given me outstanding paperwork smaples and I have provided all of the info that Cigna supposedly needs.  Paul, if you are reading this I even did the monthly doctor notes exactly as you did with diet, excersie, behavior modification and pharmocotherapy.   (not sure on the spellings right now  because I am angry , so sorry) If i have EVERYTHING they ask for is it possible to still be denied. The doctor was very impressed with my paperwork and actually wants a blank PDF version of the monthly notes...he said they were the best he has ever seen...so Kudos to you Paul!! Have many people on here been approved by Cigna and if you were denied did they say why??  Thank you.  It is just what a burst to my bubble it was hearing that!!

UGH.... not what I wanted to read. I can understand your frustration... after you've already done all the legwork! I just learned that my company may be switching from BC/BS to Cigna in January...and I have already completed everything on my checklist for the hospital. I am 4 appointments away from surgery. If we do switch to Cigna, I will have to start from scratch due to the 6 month supervised diet and then do everything over because the hospital requires all paperwork/labs/tests to be current within 6 months... Oye Yoi Yoi!!!  In preparation for switching insurances... would you be able to send me the documents you used to do your paperwork for Cigna. If you can, that would be terrific!!  Thanks. Valerie

I have Cigna and got approval for the RNY promptly with a sketchy 6 months weight loss documentation ( some of my PCP visits spread between 5-6 weeks), But I believe the quick yes was mostly due to my high BMI . I’m now trying to get approval for Duodenal Switch WLS. (Not so easy.)

One tip I would give is to write a very personal letter why you need/would benefit from WLS.  Wishing you the best of health.

Holy crap! I am so offended! My job is to assist the bariactric surgeons and patients in my office with insurance predeterminations.  I am a NURSE, not some "insurance clerk" or other "incompetent" person! Just to let you know, some of us who do pre-d's really do care about the paperwork and try to do a good job. As a RNY patient, I know what is riding on this paperwork. Unfortunately, we are not always given a lot of info to work with. There are many patients who will not sign records releases so we can get the 5 year weight history, or they insist we submit their crappy PCP records in an attempt to get their insurer to see them as a medically supervised diet. We can only submit what we have, we cannot lie. Patients often think the insurance company will make an exception for them, guess what, they won't! Just because you saw your PCP monthly for 6 months does not constitute a supervised diet! Documentation is key, if patients actually saw what their PCPs were documenting, they'd deny the surgery too. Far too many medical records only have checklists and vital signs and do not really "say" anything. Sometimes the surgeon's office doesn't forget something, sometimes the patient just did not meet the criteria you know! As for "medical clerical staffing".....I am a nurse because I like taking care of patients. If I liked ordering supplies and dealing with the budget I would be the office manager, because I AM qualified for that position as well!