I am in the beginning phase of my surgery I have done the seminar and spoke with the patient coordinator. I have Cigna insurance and would like to get my surgery real soon hopefully by the end of the year.. what wording is needed to get the help i need for approval..

I have Cigna but I wouldn't know what wording because the doctor did all the applications for approval.

I have the same question! I have to write a letter to my surgeon explaining why I want the surgery, and that has to be submitted with all of my paperwork to CIGNA. I'm an excellent writer, but for some reason I'm drawing a HUGE blank on this one!

My surgeon's insurance coordinator had a form letter for my PCP to use as a template. I have Cigna as well.

The letter from your PCP has to say that you are cleared for surgery and he recommends for surgery. Both my husband and I got denials at first and the wording was part of the denial.

My biggest issue is that the PCP I've had for years retired last month and closed his office. I have yet to even find a new PCP and when I do, I'm not sure my first appointment will go over well when I'm only there for them to write a letter:( Everything else is going so smoothly too so this is very frustrating!

The Letter of Medical Necessity from PCP(Per Cigna must be on letterhead. Must say recommending surgery & is medically cleared for surgery or must state No Contraindications)

My biggest issue is that the PCP I've had for years retired last month and closed his office. I have yet to even find a new PCP and when I do' date=' I'm not sure my first appointment will go over well when I'm only there for them to write a letter:( Everything else is going so smoothly too so this is very frustrating![/quote']

I kinda had that problem, I had to find a new PCP and I told them what I was there for and they acted like they had people in there for that all the time. And where actually glad I was doing something about being overweight.

Oh crap I have Cigna and nobody has said anything about a letter. I have Cigna PPO and don't require referrals in general. I hope to be scheduled end of year. I so don't want to go into the next year without the procedure. I will check with the office on that letter . . .

If you look in your member book (or even online under general CIGNA policy) you will see the requirements. A "clearance" from a physician, other than your surgeon, is required. I have Open Access, which doesn't require referrals either, but I don't think that matters in this case. Hope the below helps:)

I just pulled this off of the site:

An evaluation from a bariatric surgeon and your primary care physician with a resulting recommendation for surgery is necessary. A mental health evaluation is required as well as a nutritional evaluation from a physician or registered dietitian.

Thanks

Thanks for the insight I am afraid my PCP won't cooperate with my documentation so seeing that I am a RN I figured I will read every note before he submits them

Divarn34 I suggest you get a new pcp.

My advice is to just follow the first few pages of the 54 page bariatric surgery document to the letter. Cigna is really fast with approval/denials, though it may not feel like it right now. Just do exactly what they want, and you'll be fine.

Thanks for the insight I am afraid my PCP won't cooperate with my documentation so seeing that I am a RN I figured I will read every note before he submits them

Fire your pcp. If they are not on board now, how do you know they will be after the fact.

I am in Delaware with Cigna OAP.

Through my surgi center we have to:

• required WLS seminar
  
• surgical consultation
  
• GI endoscopy w/ surgeon
  
• Psych consult (she required me to start weekly sessions with a therapist and see a nutritionist 1 on 1 before she cleared me)
  
• Cardiologist consult (EKG and Echo)
  
• Pulmonologist consult for a pulmonary function test (I also had to have a sleep study as I never had one before)
  
• 3 months of nutrition classes through the joint Weight Loss Institute's program (to satisfy cigna's requirement)
  
• 3 life skills classes about the sleeve
  
• Blood work
  
• Medical clearance with endocrinologist (CLEARED! YAY)
  
• Endo submits case findings back to Surgeon's office. Surgeon's insurance case manager creates/compiles case to send to insurance company (ANXIOUSLY AWAITING AN ANSWER FROM CIGNA UGH)
  
• Then...
  
• Surgical clearance
  
• 2 weeks opti-fast
  

I am so afraid I will be denied. My surgeon's office (Christiana Institute of Advanced Surgery) works exclusively with Eugene Dupont Preventative Medicine and Rehab institute. That's where they send you for the visits with the endo, nurse practitioner, psychologist, nutritionist one on one, nutrition classes and life skills classes. So everything stays in one place and is worked on by the same people. I am hoping that will help me get approval. If I have to wait any longer for Cigna to approve me I may explode.