Cigna Questions

[ren0318 81]

Does anyone happen to know how much "weight" history that cigna requires? And also when the insurance company does require a weight history, are they looking for you to be the same exact weight for the entire history time? I mean many of us flucuate from time to time.

Thanks!

[ashiashley 42]

I'm doing major research for Cigna as well. I was told some Cigna plans require 6 mos and some require 3 mos. I am in the midst of getting everything together now for them. I am about 90 lbs overweight and was diagnosed last September with Type II diabetes. I am hoping that makes it easier for me to get coverage.

[kman95 35]

Does anyone happen to know how much "weight" history that cigna requires? And also when the insurance company does require a weight history' date=' are they looking for you to be the same exact weight for the entire history time? I mean many of us flucuate from time to time.

Thanks![/quote']

I have cigna. I had to undergo a six month doctor supervised diet before they would cover the surgery. During that time i only lost 12lbs. Had my surgery on 12-15-11 and have dropped 160lbs. It's frustating, i know, but it was worth wait.

[Jim1967 3,569]

Hi All,

I have Cigna and I also had to do the 6 month monitored diet. Cigna is really good insurance but they want documentation big time. I got denied the first time my weight center submitted because they didn't provide them with food journals and exercise logs. I had to go in and weigh monthly and see the nutritionist or nurse. I was actually approved 5 months after I started but the surgery was in month 6.

Cigna did not require a weight loss goal. They just want to see the proof that you made an effort by seeing a doc or nutritionist monthly along with weigh ins and the journals I mentioned above. I was denied on one day and approved the next less then 24 hours due to the missing documentation they wanted.

My weight center required I lose 5% before they would submit to insurance. So keep in mind Cigna may not care about that part your Doctor might. They want you to lose to 1. show commitment and 2. shrink your liver to ensure a safe surgery.

[Jim1967 3,569]

These are the guidelines I had to go by from Cigna. They could have changed and I did hear a rumor a while back they cut it down from a 6 month to 3 month supervised diet. Call and ask them they will tell you.

CIGNA covers bariatric surgery using a covered procedure outlined below as medically necessary when ALL of the following criteria are met:

• The individual is ≥ 18 years of age or has reached full expected skeletal growth AND has evidence of EITHER of the following:
  
• a BMI (Body Mass Index) ≥ 40
  
• a BMI (Body Mass Index) 35–39.9 with at least one clinically significant obesity-related comorbidity, including but not limited to the following:
  
• mechanical arthropathy in a weight-bearing joint
  
• type 2 diabetes mellitus
  
• poorly controlled hypertension (systolic blood pressure at least 140 mm Hg or diastolic blood pressure 90 mm Hg or greater, despite optimal medical management)
  
• hyperlipidemia
  
• coronary artery disease
  
• lower extremity lymphatic or venous obstruction
  
• obstructive sleep apnea
  
• pulmonary hypertension
  

• Failure of medical management including evidence of active participation within the last two years in a weight-management program that is supervised either by a physician or a registered dietician for a minimum of six months without significant gaps. The weight-management program must include monthly documentation of ALL of the following components:

• weight
  
• current dietary program
  
• physical activity (e.g., exercise program)
  

Programs such as Weight Watchers®, 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. 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. However, physician-supervised programs consisting exclusively of pharmacological management are not sufficient to meet this requirement.

Thorough multidisciplinary evaluation within the previous 12 months which includes the following:

• an evaluation by a bariatric surgeon recommending surgical treatment, including a description of the proposed procedure(s) and all of the associated current CPT codes
  
• a separate medical evaluation from a physician other than the surgeon recommending surgery, that includes a medical clearance for bariatric surgery
  
• unequivocal clearance for bariatric surgery by a mental health provider
  
• a nutritional evaluation by a physician or registered dietician
  

[dj112 21]

Hi everyone! I'm new to the forum, this is my first post. I'm 33, 5'6 240 w/ a bmi of 38. I'm considering getting the band however, I don't have any medical issues. I have Cigna; how do I get my insurance to cover it? What is the process? Thanks in advance!

[Jim1967 3,569]

Hi everyone! I'm new to the forum, this is my first post. I'm 33, 5'6 240 w/ a bmi of 38. I'm considering getting the band however, I don't have any medical issues. I have Cigna; how do I get my insurance to cover it? What is the process? Thanks in advance!

Welcome!!

I would contact Cigna directly and ask them for a copy of their bariatric coverage. What I posted above was good through May 2012 however plans can differ depending on the tier of insurance your employer purchased.

However, going by your BMI and last years policy in red is what you need to focus on. Your BMI is under 40 so they will cover it if you have comorbidities. Believe it or not the more stuff you got wrong with you the better. It will only improve your chances to get approved.

CIGNA covers bariatric surgery using a covered procedure outlined below as medically necessary when ALL of the following criteria are met:

• The individual is ≥ 18 years of age or has reached full expected skeletal growth AND has evidence of EITHER of the following:
  
• a BMI (Body Mass Index) ≥ 40
  
• a BMI (Body Mass Index) 35–39.9 with at least one clinically significant obesity-related comorbidity, including but not limited to the following:
  
• mechanical arthropathy in a weight-bearing joint
  
• type 2 diabetes mellitus
  
• poorly controlled hypertension (systolic blood pressure at least 140 mm Hg or diastolic blood pressure 90 mm Hg or greater, despite optimal medical management)
  
• hyperlipidemia
  
• coronary artery disease
  
• lower extremity lymphatic or venous obstruction
  
• obstructive sleep apnea
  
• pulmonary hypertension
  

[JustMeDee 34]

i have Cigna (Florida) and as of April 2012 they required:

6 month wait of monthly checkin and weigh in. They ask me every month how i'm trying to loose weight.

A psych eval and she must sign off

A dietician eval and she must sign off

An approval letter from your primary doctor w/ medical clearance

Hope this helps.

[Msbritt 45]

You need to contact them. I have just changed to Cigna. I live maryland and they require bmi of 35 or more with one health condition or a bmi of 40 or more with no health conditions. I have to prove 3 months of physican supervised weight loss program.

[dj112 21]

Thanks everyone! The problem is I don't have any comorbidities and I'm NOT gaining weight to increase my BMI that is really stupid. Perhaps I can find a doctor to write a letter saying that I have sleep apnea.

[JustMeDee 34]

after reading what Jim1967 wrote above I called Cigna and they did tell me the length of time has been changed to 3 months. Have a call into my doctor and hopefully he says i can have it done in August. Fingers crossed.

[Jellyfish 17]

Hello. I have Cigna, I was just approved through them for my surgery date on August 2nd. They have definitely dropped their requirement from 6 to 3, as of June or so. Lucky you!! Unfortunately, Cigna also likes to wait the full 30 days that they are allowed before making a decision on your approval, from the time that the doctor submits it to them. Several of the nurses at my doctors office warned me about that, their Cigna patients almost all had to wait 30 days for an approval. In my case, I had to wait 29 days. I did try all of the things that are supposed to get you approved faster (calling every day, being extra polite etc). It didn't make any difference for me but maybe you'll be different!

They are allowed 30 days from the time you submit your paperwork, not 30 'business days' (I had a few reps from Cigna tell me that. It's incorrect per my doctor) so don't let anyone tell you that. I did get one awesome rep one time I called who seemed like she really wanted to help me. She said that if the doctor submits a preliminary surgery date, the lower level reps can forward your paperwork up to the 'supervisors' who will look it over and approve it. My office doesn't give preliminary dates, but if yours is willing to that may get you a sooner date. Good luck!!

[Jim1967 3,569]

Wow, the 30 days is surprising. I was denied on day 2 after submitting for not providing food journals and workout logs and they also had my birth date wrong and thought I was under 18. All of that was corrected and re-submitted on day 3 and I was approved on that afternoon.

[Jellyfish 17]

I've been wondering about that. Several people on here don't seem to have trouble, but the nurses tell me it's EVERY Cigna patient. They told me that back in March when I started this journey. I wonder why it's different for them? Do you know if your doctors office sent Cigna a preliminary date when they submitted you? Maybe that's it.

[CIGNAQuestions 0]

Hello,

I can assist you with your questions if you send me an email to LetUsHelpU@cigna.com. Please include your Cigna account information.

Thank you,

CignaQuestions