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've called Cigna twice to confirm that I don't have to do the 90 days....the rep I spoke to said there was nothing in my policy stating I had to.

THEN THE SURGEONS INSURANCE COORDINATOR CALLED ME - she says I have to do 90 days. ?????

I'm doing the NUT started it Monday and desperately trying to get the surgery done this year.

I also started Medifast last month with PCP. But I don't have documentation for it.

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

Thanks Ladies...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.

I really hope it works out...if not i'll have to work on plan B....out of pocket! But I hope to hear something next week. how long did it take for u to get a response? How long was U off from work? 2 weeks? 3 weeks...longer?

I got approved sept 6 sleeved sept 30the.

I was off work just two weeks. But I feel great,

Sucks jumping threw hoopes just to run into insurance issues....but they are usually easy to fix