wording to use for CIGNA approval

[divarn34 0]

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..

[Pinky Green 260]

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

[LittleLou 31]

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!

[auntmissa1 39]

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

[evansmini 8]

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.

[LittleLou 31]

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!

[CMWSleeved 10]

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)

[sdrussell22 4]

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.

[Ms Sixx 1]

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 . . .

[LittleLou 31]

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.

[Ms Sixx 1]

Thanks

[divarn34 0]

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

[blaze_pixie 1]

Divarn34 I suggest you get a new pcp.

[karpouzian 94]

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.

[karpouzian 94]

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.