Cigna Revised Policy

[MrzSongbird 53]

Will do.....isn't it amazing all the different responses. Uggh can't wait to get through this next 3 or 6 months.

[Nikki613 120]

Who knows. Hope its right! Im so ready.lol

[JustSleeveMe23 15]

You should call your surgery coordinator. Cigna customer service doesn't always get the correct information as quickly.

[MrzSongbird 53]

Can anyone help me with how I must pay my deductible an so forth. I have Cigna as well. Cigna said I will have a hospital copay of 250 a deductible of 200 and my Out of pocket is 1500. Do all these monies have to be paid in full before surgery can take place?

[JustSleeveMe23 15]

It varies by the surgeon and hospital. Prepare to pay at minimum your $250 copayment and $200 deductible. My hospital requires the inpatient copayment and deductible and the rest I will be billed for. Your out of pocket and deductible are low! My deductible is $750, copay $250 and out of pocket $2500.

[beverlykm 1]

When the Dr's office called Cigna, they stated it was still 6 mo for me as well. She said it may have to do with my group plan? I'm not sure, but I guess not all Cigna customers have the same benefits.

[JennyB 25]

I did do weight watchers for about 7 months before my first visit, but this was not turned in the Cigna. The only things we submitted was my labs/EKG reports from my pcp a letter of medical neccessity from him, a letter of clearence from a psychiatrist, documentation from a nutritionist. Got denied originally due only to the hospital they submitted (submitted on Friday, denied on Monday), they changed the hospital and I was approved in less than 24hrs.

I am thinking maybe it has something to do with my high BMI, but I don't have any major related health conditions (thank God) I was actually anticipating it being rejected with not having documentation of the 6 month diet plus not having comorbidities.

[MrzSongbird 53]

That's awesome makes me wanna tell them submit mine now, bmi is 53. When is your date?

[MrzSongbird 53]

I also have high Bp, sleep apnea, and joint pain.

[JennyB 25]

That's awesome makes me wanna tell them submit mine now, bmi is 53. When is your date?

Tomorrow morning! EEKK!!! I can't decided if I am more scared or excited yet!

[MrzSongbird 53]

Oh I'm so envious....all the best to you! Wishing you a speedy recovery and I will see you on the losers bench.

[JustSleeveMe23 15]

When the Dr's office called Cigna, they stated it was still 6 mo for me as well. She said it may have to do with my group plan? I'm not sure, but I guess not all Cigna customers have the same benefits.

Cigna updated their online policy today. You may want to present this updated copy to your surgeon. It should be nationwide for Cigna members without an exclusion. It's right at the top of page 2.

http://www.cigna.com/assets/docs/health-care-professionals/coverage_positions/mm_0051_coveragepositioncriteria_bariatric_surgery.pdf

[beverlykm 1]

I happened to call my benefits number directly and asked about the policy that I had also found last night....I guess because I belong with NALC who is partnered with Cigna, NALC can still make decisions that can override Cigna. Very confusing to me since most medical care I deal with is just plain Cigna. I just happend to catch the one snag.

[mel2643 68]

Justsleeveme23 , I also looked at the policy but where you write its on top of page 2 ( 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. ) is talking about a weight management program ....

However the next bullet states the 6 months

A thorough multidisciplinary evaluation within the previous six months which includes ALL of 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 requesting surgeon that includes both a recommendation for bariatric surgery as well as a medical clearance for surgery

 unequivocal clearance for bariatric surgery by a mental health provider

 a nutritional evaluation by a physician or registered dietician "

[Nikki613 120]

Mel2643 I think you are reading it wrong.

Justsleeveme23 , I also looked at the policy but where you write its on top of page 2 ( 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. ) is talking about a weight management program ....

However the next bullet states the 6 months

A thorough multidisciplinary evaluation within the previous six months which includes ALL of 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 requesting surgeon that includes both a recommendation for bariatric surgery as well as a medical clearance for surgery

 unequivocal clearance for bariatric surgery by a mental health provider

 a nutritional evaluation by a physician or registered dietician "