CIGNA people-How long did it take for approval/denial?

[Freebird 0]

You need to stay on top of it. I called first thing in the morning and then again mid afternoon. I learned the hard way that when they "put a rush on it", they actually do NOTHING. You need to verify that your paperwork is indeed in the medical review department and that it is a PRE DERMINATION OR PRE CERTIFICATION, depending on how it was submitted by your physician.

[TX_IT_Chick 0]

Ok, called again today. I was told to call another dept entirely, only to be told that they didn't handle pre-derterminations. Back to Cigna main line!

Called back and firmly spoke with the rep, and when I asked, I got to talk to a supervisor out of Denison, TX. I have her name as well. I asked how to get back in touch with her. She has my cell number and said that she'll give me a call in 2-5 business days to tell me what the result is. So Friday, I'll be calling again.

I also went to the dr today (someone canceled their appt and I was able to get in), and a nurse there said that her husband has lap band. I told her I'd jumped thru all the hoops; she told me that I'll get approved, just takes time. Boy am I tired of hearing that!! I don't know if I'm being squeaky enough or not!

I'm sure sick of this waiting!!!

Shandra

[TxArcher 2]

Ok, called again today. I was told to call another dept entirely, only to be told that they didn't handle pre-derterminations. Back to Cigna main line!

Called back and firmly spoke with the rep, and when I asked, I got to talk to a supervisor out of Denison, TX. I have her name as well. I asked how to get back in touch with her. She has my cell number and said that she'll give me a call in 2-5 business days to tell me what the result is. So Friday, I'll be calling again.

I also went to the dr today (someone canceled their appt and I was able to get in), and a nurse there said that her husband has lap band. I told her I'd jumped thru all the hoops; she told me that I'll get approved, just takes time. Boy am I tired of hearing that!! I don't know if I'm being squeaky enough or not!

I'm sure sick of this waiting!!!

Shandra

It will come Chick. KEEP squeaking away! Now that you got through to a supervisor and have her name, USE IT!

[flipbarnett 0]

:clap2: I have Cigna as well. I started the process in July, after 2 years of research. My paperwork was filed November 16th. I got the call Monday, December 10th that I was approved!!! I couldn't believe it. With so much disappointment in my life, I thought the worse. I go for my pre-op and dr visit Monday December 17. I should know then when my surgery is. It looks like January. That's ok with me. Start the year off with a new me. I didn't call Cigna at all. My Dr. office took care of it all. I had everything but the 6 months weight loss, completed back in August. I thought I'd never get the rest. I do know you have to turn it all in together. Cigna wont accept if the paperwork comes in all separated. Good luck I hope you get the approval soon.

[TX_IT_Chick 0]

Found out today that I was denied by Cigna.

While my BMI is between 35-40 I didn't have any co-morbidities to justify them paying for my lapband. I'll get the letter in a few weeks.

So now I'm going a different direction and will be a self pay; I CAN NOT WAIT another 30 days for an appeal. I have to make some changes in my life and they have to start soon. My birthday is in Feb so this will be my present to myself.

My company C'mas party is tonight and I plan to make my pain go away with some adult beverages.

Thanks for the support that I have been given on this part of journey. I wished that it had turned out the way *I* wanted it to.

Shandra

[TxArcher 2]

Sorry to hear that Chick... Sorry.

[Joaquin 0]

It took forever but I was finally approved. My advice like everyone elses is to stay on top of it. Call them everyday!

[Joanna240 0]

Took 6 weeks for Cigna to approve me after the surgeons office submitted the 75-page fax. Surgery is scheduled for Jan 16, 08.

I was hoping to get the surgery done in '07 because I had satisfied a $400 deductible but no, Cigna drug it out so I have to pay a % plus the $400 deductible. With Cigna paying for it, costs me approx $2,500 out-of-pocket which I'm not complaining, I'm thrilled Cigna is paying most of it or I couldn't afford to have it done although I'm desparate to get this weight off.

[stacey4870 0]

hi can u send me that process too, I also have cigna, and am sooo worried about not being approved. Thanks Stacey

[Guest givmemo]

I would love to know what diet plans were used by each of you, my doctor and I followed the Cigna position statement completely and he documented all of my vital statistics and what I had done in terms of diet and excercise every month, we did exactly what they had said we needed to do.

Because it said in thier statement that Weight Watchers alone was not acceptible that you also had to have your doctor moniter you for 6 months I called ahead of time to be sure what I was doing was acceptible and that they would indeed accept Weight Watchers with the doctor supervision included.

I was told that they would, I also checked thier website to see what diets they promoted and they listed weight watchers as a moderate weight loss option, so with all that in hand I was sure I was good to go.

I not only put in 6 months of doctor visits but 8 months because my doctor was sick on my 2nd month and I had to delay an appt so I didnt have an appt fall in the month of January, so to be absoultey sure I added two extra months on, I didnt want to risk that they deny me..

I finally submitted to Cigna and was stunned that they denied me saying that Weight Watchers (WW) was not acceptible.

I have been working on this for over a year and have been denied twice, I considered starting the 6 month program over again but cant get a straight answer out of Cigna on what they will accept and have been lied to on 3 different occasions so I decided that my best course of action was a legal one.

I am currently working with obesitylaw.com and the Allergan advocacy group and will be going to mediation with an independant surgeon sometime in the next 2 weeks.

This is why I was hoping one of you could give me some examples where people have been accepted using WW, particularly anything in writing from Cigna would be great because any additional documentation I can get, it could mean the difference between getting approved and not getting approved.

Thanks,

Janine

[Sooverit! 1]

Well...it took 6 weeks supposedly for CIGNA to receive my paperwork from my surgeon's office then it took Cigna 2 weeks to turn down my claim because my BMI was not 40 for a year. I plan to appeal and then start this up again as I am a 40 BMI now. I may change surgeon's as well to a local doc Dr. Geiss on Long Island. Yes it cost me a small fourtune to go through all this but I can write a book about the whole proceedure now....good to see the positive.

Marg

Oh and it took a year for my PCP to get the 6 month diet paperwork correct! :thumbs_up:

[Sooverit! 1]

Just looked on the appeal site that was posted by someone here and I change my mind I CAN NOT throw any more money away on this...! I will not appeal....thinking of perhaps changing to Aetna if possible and starting the procees all over again now at a BMI of 40 - not that that's not gonna cost me too.... Any opinions?

[celticdreamer 0]

Marg,

Please do yourself a favor and find Cigna's position statement on bariatric surgery on their website. If it doesn't say that you have to have had a BMI of 40 or greater for one year, please fight them.

Cigna makes people do the six month diet thing. I wonder if that's in an effort to get BMI < 40 so they can deny coverage. Ah, guess not, as from what I've read, they tend to deny anyway.

Good luck to you!

-Theresa

[oscarel 0]

Well...it took 6 weeks supposedly for CIGNA to receive my paperwork from my surgeon's office then it took Cigna 2 weeks to turn down my claim because my BMI was not 40 for a year. I plan to appeal and then start this up again as I am a 40 BMI now. I may change surgeon's as well to a local doc Dr. Geiss on Long Island. Yes it cost me a small fourtune to go through all this but I can write a book about the whole proceedure now....good to see the positive.

Marg

Oh and it took a year for my PCP to get the 6 month diet paperwork correct! :frown:

Cigna's Coverage Position clearly states you must have >40 BMI for over 12 months. The document they referenced me to was mm_0051_coveragepositioncriteria_bariatric_surgery.pdf. Here's the first part of that document.

CIGNA HealthCare covers bariatric surgery using a covered procedure outlined below as medically necessary when ALL of the following criteria are met:

• The individual is ≥ 18 years of age or has reached full expected skeletal growth AND has evidence of one of the following:

BMI (Body Mass Index) ≥ 40 for at least the previous 12 months.

BMI (Body Mass Index) 35–39.9 for at least the previous 12 months with at least one clinically significant comorbidity, such as a serious cardiopulmonary problem, Type 2 diabetes, hypertension, coronary artery disease, or pulmonary hypertension that has failed to

respond adequately to appropriate medical management.

• Active participation within the last two years in one physician-directed weight-management program for a minimum of six months without significant gaps. The weight-management program must include monthly documentation of ALL of the following components:

Vital signs, including weight

Current dietary program

Physical activity (i.e., exercise program)

Behavioral interventions to reinforce healthy eating and exercise habits

Consideration of pharmacotherapy with U.S. food and Drug Administration (FDA)- approved weight-loss drugs, if appropriate For individuals with lifelong, morbid obesity, participation in a program within the last five years is sufficient if documentation of six months is available and reasonable compliance with the weightmanagement program over an extended period of time can be demonstrated. However, diet programs/plans alone, such as Weight Watchers®, Jenny Craig® and similar plans, are not considered physician-directed weight-management programs and do not meet this requirement. Similarly, physician-directed programs consisting exclusively of pharmacological management are not sufficient to meet this requirement.

[Guest givmemo]

It is my firm belief that Cigna will deny you automatically just to see if you will go away, and then if there is anything that they can possibly contort in any way to thier benefit they will deny you again.

I would suggest you talk to the people at Obesitylaw.com, you have nothing to lose and if you are accepted into the Allergan/Inamed Advocacy group there is no cost to you either.

Because it is a clear exclusion I am not sure if they can do anything for you but you never know until you try.

Godo luck with it.

Janine