Jump to content
×
Are you looking for the BariatricPal Store? Go now!

wording to use for CIGNA approval



Recommended Posts

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..

Share this post


Link to post
Share on other sites

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

Share this post


Link to post
Share on other sites

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!

Share this post


Link to post
Share on other sites

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

Share this post


Link to post
Share on other sites

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.

Share this post


Link to post
Share on other sites

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!

Share this post


Link to post
Share on other sites

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)

Share this post


Link to post
Share on other sites

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.

Share this post


Link to post
Share on other sites

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 . . .

Share this post


Link to post
Share on other sites

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.

Share this post


Link to post
Share on other sites

Thanks

Share this post


Link to post
Share on other sites

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

Share this post


Link to post
Share on other sites

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.

Share this post


Link to post
Share on other sites

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.

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now

  • Trending Products

  • Trending Topics

  • Recent Status Updates

    • Hesitant but hopeful

      Hey October Surgery friends...how are you doing? I've lost 15 lbs since surgery on 18th.42 lbs overall. Wearing clothes that feel great. Had a bout of cold and stomach flu and still having some nausea off and on after that but getting better, I think. 
      Seems like I fill up and have minor pain quicker when I eat hot foods rather than cold. Anyone else notice this?
      Still sooo glad I did this.
      · 1 reply
      1. Bettyboop56

        I had surgery Oct 29. Lost 35#. Plateau now. But seeing what clothes fit now is encouraging.

    • Merri Beth  »  SamaLotus

      Hi I just saw that you are in Las Vegas too. We are going to the same center. Dr Laduc in same office as Dr Atkinson, is doing my sleeve on Nov. 28th.  I wish you the best!
      · 0 replies
      1. This update has no replies.
    • Jessica100858

      24 days and counting down til surgery 
      · 0 replies
      1. This update has no replies.
    • Bunny78

      Just over 2 weeks post-op….I’m getting there
      · 0 replies
      1. This update has no replies.
    • Voogs  »  KimA-GA

      always look forward to your updates, Hope you are well.
      · 0 replies
      1. This update has no replies.
  • Recent Topics

  • Hot Products

  • Sign Up For
    Our Newsletter

    Follow us for the latest news
    and special product offers!
  • Together, we have lost...
      lbs

    PatchAid Vitamin Patches

    ×