wording to use for CIGNA approval

[Missylaneous 27]

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.

[divarn34 0]

I truly understand I was trying to do a surgery before and was not able to do so my weight gain is not up significant amounts but it is not going down.. My PCP is working with me ???????? I saw him today as well as my dietitian I have to do the 3 month prep.. I have always thought that we r supposed to be practicing preventive medicine so I feel that the surgery is just that PREVENTIVE Medicine.. GOOD LUCK

[LittleLou 31]

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.

My list of things to do is a lot like yours, I'm so nervous too:(

[waitingtoexhale 174]

My PCP is NOT on board with WLS!! Ugh!

Edited August 6, 2014 by waitingtoexhale

[waitingtoexhale 174]

Good morning ladies and gents! I just found out that NALC only get quotes from Cigna they don't actually insure us! NALC don't require a PCP approval letter just the other common paper work???????? I'm still waiting on NALC to review and approve???????? I'm so excited!!

[Jersrose43 837]

Good morning ladies and gents! I just found out that NALC only get quotes from Cigna they don't actually insure us! NALC don't require a PCP approval letter just the other common paper work I'm still waiting on NALC to review and approve I'm so excited!!

Congrats - yes NALC rents the cigna network, they make their own rules.

Many unions and other companies do this. The rules therefore are different than traditional cigna rules.

[Yennoe 3]

I have Cigna too, and am coming up on my 60-day supervision appointment on the 15th. Just one more month of that! Went to the seminar Wednesday and have my first clinic appointment on 8/18.

Hope this goes smoothly for us all!

[imreadynow 18]

I modified this letter below and sent it to my PCP. It needs to be on their letterhead:

[Date]

Re: [patient’s name]

Date of Birth:

To whom it may concern:

[Patient’s name] has been a patient of mine for [insert number] years. Patient is [insert height] tall and

weighs [insert weight] pounds for a calculated BMI of [insert number]. This patient has been excessively

overweight for the last [insert number of years] and will benefit from Bariatric surgery.

The patient is medically cleared for surgery. An EKG [also insert names of other tests included such as

laboratory tests, stress test, echocardiogram, sleep study and/or PFT] is provided with this letter.

In addition to morbid obesity, the patient is suffering from the following co-morbid conditions: [insert

conditions, e.g. exertional dyspnea, urinary incontinence, obstructive sleep apnea, hypertension,

diabetes, degenerative joint disease, osteoarthritis, hypercholesterolemia, hyperlipidemia, shortness of

breath, etc].

The patient has tried many methods of weight loss including appetite suppressants for [iF appetite

suppressants were tried - insert length of time], with [insert number of pounds lost and whether they were

regained or not], physician-administered diet plans for [insert length of time] and [insert number of pounds

lost and whether they were regained or not], Weight Watchers, etc. The patient is limited due to his/her

co-morbidities in his/her ability to exercise but has tried [list all attempts and any successes or regaining

of weight].

Family medical history is positive for [insert medical conditions, e.g. obesity, hypertension, diabetes,

hypercholesterolemia, etc].

I am supportive of this patient’s desire to proceed with Bariatric surgery. The patient has a good

understanding of the risks involved and reasonable expectations and understands the importance

of being compliant with all post-surgical requirements. I will also continue to support this patient’s primary

care needs should they proceed with surgical intervention. I am respectfully requesting consideration for

Bariatric surgery.

Thank you for your attention in this matter.

Sincerely,

[signature and typed name of PCP]

[mrsknox 1]

I also have Cigna, I just found out after meeting with my PCP for the first appointment that my Cigna plan doesn't cover any bariatric surgeries.. Can I do anything other then pay out of pocket?

[Jersrose43 837]

I also have Cigna, I just found out after meeting with my PCP for the first appointment that my Cigna plan doesn't cover any bariatric surgeries.. Can I do anything other then pay out of pocket?

If your employer plan excludes it then no nothing you can do. But you should call Cigna to determine what the situation is correctly

[waitingtoexhale 174]

I received a call today 8/26/14 informing that my VSG procedure was approved on Friday 8/22/14!! the insurance rep also stated that I have approval for the RNY too!!! Now I'm waiting on the call for surgery DATE

[burdettejj 0]

If you log in to your myCIGNA account, in the search option type in plan documents, you can pull up a Certificate of Coverage which will explain what your specific plan covers.

I was able to locate mine and found the only reference to weight loss surgery was in the Exclusions area and states that it will not be covered if it is not medically necessary.