My coverage with Cigna indicates that I only need to do the weight loss management program with my PCP for a minimum of 3 months. My surgeon's office submitted my paperwork to Cigna last month and they denied me on the fact that I supposedly only did 2 months of doctor supervised weight management. Here is the kicker... I actually did 5 months as I thought it required 6 months instead of the three. I am so frustrated right now about this because it's just stupid! My surgeon's office thinks we have a new person in Cigna and that they are counting the first visit as the "initial visit" which then means you have to go 4 months instead of 3. Of course in my situation that shouldn't matter as I went 5. What really frustrates me is the only good time I have to do the surgery is in August, otherwise other people are going to have to adjust their schedules for me to miss work. Hoping that this gets resolved quickly so we can still be on schedule.

All I can say is GRRRRR

My first appt. was with the bariatric doctor in April and I had one in May, June and July. I didn't go to a PCP (didn't have one) until June and she sent me for the blood work and did the EKG, etc. She also signed the required letter stating she recommended me for the surgery. Keep in mind, if your insurance is like mine, you have to have 90 days elapse between the 3 physician visits before submitting. For example, you can't go for the first on June 30th, next on July 30th and last on August 1st. I am thinking you will have to submit in Sept which is right around the corner. My surgery is tomorrow. Woo Hoo! Good luck to you and stay positive!

My first appt. was with the bariatric doctor in April and I had one in May' date=' June and July. I didn't go to a PCP (didn't have one) until June and she sent me for the blood work and did the EKG, etc. She also signed the required letter stating she recommended me for the surgery. Keep in mind, if your insurance is like mine, you have to have 90 days elapse between the 3 physician visits before submitting. For example, you can't go for the first on June 30th, next on July 30th and last on August 1st. I am thinking you will have to submit in Sept which is right around the corner. My surgery is tomorrow. Woo Hoo! Good luck to you and stay positive![/quote']

I'm so happy for you! Good luck! I went in late June ( just like I'm doing in July ) and I'm just so ready to knock August so it can be September. I am crossing my fingers that they wont deny me.

My surgery is tomorrow. Woo Hoo! Good luck to you and stay positive!

Good luck Altzma!

Finally got approval, now just need the surgery date.

My Cigna policy is self insured -meaning the claims are paid by my husbands company and not by Cigna. Cigna is the administrator of the policy. In my 70 (exaggerating) policy guidelines it states the following and does not refer to Cigna's bariatric guideline.

"Exclusions, Expenses Not Covered and

General Limitations

Exclusions and Expenses Not Covered

Additional coverage limitations determined by plan or provider type are shown in the Schedule. Payment for the following is specifically excluded from this plan:

for medical and surgical services intended primarily for

the treatment or control of obesity. However, treatment

of clinically severe obesity, as defined by the body mass

index (BMI) classifications of the National Heart, Lung

and Blood Institute guideline is covered if the services

are demonstrated, through peer-reviewed medical

literature and scientifically based guidelines, to be safe

and effective for treatment of the condition."

I have a BMI of 46 and two comorbitities.

I need some advice regarding the wording. Does this mean as long as I have my PCP referral and my bariatric surgeons recommendation - that the 90 days are not required. Just a peer to peer between my surgeon and Cigna?

I'm doing the NUT started it last month and desperately trying to get the surgery done this year. We've met all our deductibles and 20% co insurance. My husband had a liver transplant earlier thus year -he had cancer. He's great now.

My biggest fear is that with Obamacare on the horizon that Cigna may change their policies or even worse my husbands company will change their policy in Jan. 2014. I'm really scared. I really need and want to get this done.

I've been caring for everyone else but myself for so long!

Any words of advice would be greatly appreciated.

Regards - Carmen

Approved by Cigna yesterday. Only took 2 weeks

Thanks to all of you...just working my way through all the pre-req's -regardless of whether it's 90 days or less. I decided not to get upset about what I could not control. I'm doing everything I can to knock things off the list.

Done:

Started NUT meetings with my surgeons recommended contact.

Did my psych eval and passed

Letter from my PCP

Met with cardiologist and did stress test and passed.

Had Upper GI that my surgeon wanted -barium is nasty stuff.

Having endoscopy and colonoscopy done next Wed. Sounds like fun huh?

Sent out all medical records requests for my surgeon from prior procedures and issues.

To Do: finish my NUT classes and lose 15-20 pounds before surgery. I've lost 4lbs from just walking 2 miles a day.

My insurance coordinator is going to send the package out -just to see what Cigna says. Does not hurt to try.

Other than that -just excited about doing something just for me and bettering my health.

Thanks so much for letting me vent. I really was scared. But I'm in a good space now.

Will 6 months of weight management with PCP replace nutritionist visits or are both required?