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I'm new to the forums as I have been viewing the site for a bit now. I've just started the weight loss surgery process and had my first consultation today. I've been so excited! However, for some reason, I've been feeling like I was not going to be able to take the next steps due to insurance. Lo and behold I got a call a while ago from the surgery office saying that Aetna has no provision in my plan to provide for any surgery.
I feel like there was no explanation other than "they won't do it" and now am feeling forced to look into financing options.
Has anyone else dealt with this? I am so blindsided that I'm unsure of my next step when I know this is something I need to keep looking towards doing.
Any input would be greatly appreciated!
on 8/18/11 3:22 am
Hopefully the end of Sept. I will be posting the same, Im going through BCBS Federal. That's awesome news! Aetna came through!! 
lol 
http://www.cigna.com/customer_care/healthcare_professional/coverage_positions/medical/mm_0051_coveragepositioncriteria_bariatric_surgery.pdf
The info is on page 2. "It does state it needs to be in conjunction with a physician or registered dietician." then followed with "For individuals with long-standing, morbid obesity, participation in a program within the last five years is sufficient if reasonable attendance in the weight-management program over an extended period of time of at least six months can be demonstrated"
You may be able to appeal.
Pre-band surgery weight: 233
Lowest: 199 ( for, like, a day)
CW: 260 (yes, with the band!)
Current Fill: 5cc in 10cc band
BMI: 49
Pre-band surgery weight: 233
Lowest: 199 ( for, like, a day)
CW: 260 (yes, with the band!)
Current Fill: 5cc in 10cc band
BMI: 49
Pre-band surgery weight: 233
Lowest: 199 ( for, like, a day)
CW: 260 (yes, with the band!)
Current Fill: 5cc in 10cc band
BMI: 49
Nan
HW 300 / SW 280 / CW 138 / GW 140
Hit Goal 4/2/2010
I just got my first denial letter based on CIGNA needing additional information from my surgeon as well as a letter from at least one other physician stating that I need to have surgery. They are also requiring the 6 month medically supervised weight loss program. When I first contacted CIGNA back in April I asked them if Weigh****chers was sufficient and they said it would be, now they are saying it's not accepted, it has to be documented by a doctor. What a waste of my time!
My question, has anyone ever been able to get CIGNA to waive that requirement? Just in case, I am meeting with the nutritionist on Friday to start a program but I'm hoping that we can either lessen or waive the requirement.
I have a BMI of 60, I have sleep apnea, high blood pressure, joint issues...I'm 35 years old and I've tried every weight loss program under the sun. What more do they want?!? Sorry, just frustrated right now.
I have my PCP and OB both writing letters and I'm going to write a letter as well as the Bariatric Nurse. Hopefully we can make this happen but please let me know if you've had any experience or success getting this waived.
Thank you!
Erica
Hockeymom87 · 0 replies · 735 views
