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I do have coverage for the surgery and they told me I need a 3 months supervised diet which was fine with me but reading others experience got me worried because some had cigna and they were requiring over 6 months of supervised diet. I already did my orientation online and sent the surgeon my medical history package and I am waiting it to be reviewed by the surgeon so they can call me for an app. The only problem is that I do not have a PCP( I am not from US, didn't have insurance before until 2 years ago and I have been to 2 PCP once but didn't like them). Not sure if just a letter form the surgeon to the insurance would be enough or if I could use my obgyn. Hopefully all goes well with you and you get your approval letter soon.
Hi there - I'm a little further into the process now and can tell you what I've learned so far. Cigna's requirement is the 3 month supervised diet. You have to have four doctor's appointments, each at least 30 days apart. You don't have to lose weight while on it though - which is good if your BMI is close to 40 already. My best advice would be to first make sure that your individual Cigna plan covers the surgery. Then take a look at Cigna's specific requirements for coverage, found on their site here: https://cignaforhcp.cigna.com/public/content/pdf/coveragePolicies/medical/mm_0051_coveragepositioncriteria_bariatric_surgery.pdf
If you meet these specific requirements, then they will approve you. My surgery program takes care of the dietician, physician, psychologist and surgeon recommendations/clearance, so I'm having my PCP take care of the three month requirement and send a letter recommending that I have the surgery. Definetely the first step is go to a seminar at your surgery center. Chances are they have a pretty robust program like that also. If you go through their program and make sure you do the necessary extra steps that Cigna details out, you should have no problem! I haven't gotten approval yet, but I will submit after February 7th (my final weigh in of the 3 months). After that I'll let you know how it goes!
HW: 263 CW:245 GW: 140
I can't tell you anything about it, but i am just writing to share that we have a very similar situation. I am 5'6" and about 250 lbs now. I have gained 20 pounds in the last 3 months but was on 230 for a couple of years. I have Cigna as well, and they told me I also have to be on a 3 months supervised diet. I have not seen a doctor yet but I was concerned about the same thing. Hope we can find some answers to this because I have been reading so much about it and how people who have Cigna had such a hard time being approved and how they had to be on supervised diet for 12 months or so that I am feeling a little scared but I will try anyway. I still have to go to an orientation and see a doctor but I am going to stay positive.
I know this is an older question (im new to the boards) however, i have UHC choice plus and was told no diet and no history needed...just to inform prior to surgery. Can you please tell me how yours went in the end?
I was told through UHC no 6 month diet needed with a BMI greater then 40+
I just called UHC yesterday, as my benefits start as of 1/1/14. I asked specific questions and was told
*BMI 40+
OR
BMI 35 with medical complications etc.
no 6 month diet, no referrals, no other contributing factors other then informing them prior to surgery to avoid a fee.
good luck! :)
Hello, we have Cigna...care allies and they have denied the claim stating that they are not in receipt of documentation under a physicians care for 3 months, supervised or registered dietician, or supervised weight mgmt for 12 months. This is not true, the bariatric surgeons office has submitted it and called them to verify receipt. My husband is about 5'7" and weighs nearly 300lbs. He has sleep apnea, high blood pressure, and degenerative joint pain in his knees and back. If anyone can assist, your advice/guidance would be greatly appreciated.
Hello
I am a newbie and I have UHC Community Plan through Medicaid. I have a surgeon and have completed 6 months NUT visits and Psych Eval and am as of right now waiting for the hospital to submit my papers for approval. My question is has anyone else gone thru this process with Maryland UHC Community Plan.
Thanks in advance.
on 12/6/13 9:25 pm
I received a notification from Cigna today that my request for an independent review of their denial was being sent to a company called MCMC which I think stands for medical care management corporation. Has anyone else had any contact or experience with these guys before?
Basically what happens is that they will get a nurse or a doctor to read your paperwork and medical records and make sure the insurance company is following the policy to a T. If they are, they will likely side with the ins co.
I wish I would have known about this before you requested a an independent review. They will have the final word. I would have given you more info for an appeal. That would have given the medical professional reason to side with you. For example, studies showing that diagnostics are not the only issue when dealing with bands. Scar tissue is what usually causes the most problems that you describe and that can't be seen until they do surgery.
Hockeymom87 · 0 replies · 857 views
