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Great West Insurance thru Cigna PPO

AllisonK1986

By AllisonK1986, in Insurance & Financing

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AllisonK1986    68

AllisonK1986
Posted

Does anyone else have this insurance? Called my agent and said they will pay as long as I can prove that I'm morbidly obese. Has anyone had any experience with them?

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India928    81

India928
Posted

I have them as well. My surgeons office is in the process of submitting my paperwork to them this week. I will let you know the outcome once I have word.

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India928    81

India928
Posted (edited)

I will tell you that you will need at least three progress notes from your PCP indicating that he is monitoring you on a weight loss program. Basically he has to complete: Monthly weigh in's with you, ask you if you have been exercising and if so doing what and for how long and as of what diet you are incorporating (ie. Low fat; low sugar; shakes; Atkins....ect) AND then he also has to write you a letter of support.

In addition to all the usual stuff everyone has to do: Endoscopy; nutritionist; psych; abdominal sonogram; bloodwork up; etc....

I will definitely let you know my outcome ;)

Edited by India928

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India928    81

India928
Posted (edited)

oh one more thing, the progress notes from your PCP have to be 30 days apart. If you saw him on 1/12 your next appt. must be no sooner than 2/13; next one 3/14; 4/15 and so on

Edited by India928

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Daisee68    2,493

Daisee68
Posted

I have Cigna Open Access plan? (Not sure it is same as your plan but hope this helps.) Look at this link that someone else on this site gave me - I found it very helpful - https://cignaforhcp.cigna.com/public/content/pdf/coveragePolicies/medical/mm_0051_coveragepositioncriteria_bariatric_surgery.pdf

The only thing they gave me grief about was the sleep study because the dr hadn't actually proved medically necessary (hadn't shown signs). They did eventually agree a home sleep study. Once everything was done and submitted, they agreed in less than 1 day. There is a 3 month supervised diet requirement occurring within the last 12 months and allow Weight Watchers, Jenny Craig, etc. as long as it was supervised / documented by a doctor. They do require a letter by someone other than the WLS surgeon recommending you for the surgery.

I had my first surgeon appt on Jan. 20. Approved on May 1 and surgery on June 4. (I could have probably done surgery a little earlier once approved but I just had some work conflicts.)

Hope that helps!

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AllisonK1986    68

AllisonK1986
Posted

Thanks daisee! I have arthritis and sjogrens since I was 15 and pcos so I have documentation from many Drs regarding my morbid obesity. I don't have a specific letter, but my pcp sent over the last 3 years of my medical records and I will get Obgyn and rheumatologist to do as well. My first appt with the dr is on July 2. So I'm hoping everything goes smoothly and these 3 months fly by. I'm also praying my copay isn't too high. Bc anything more than 2k I can't do the surgery since I'm already in debt ????.

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India928    81

India928
Posted

AllisonK:

My packet was submitted on Thursday June 18th. The scheduler was out sick a couple of days earlier in the week, which held up my packet from being submitted. Regardless, today is Wednesday June 24th and I received word that I have been approved by CIGNA PPO GWI.

Insurance did require all the documents, consults and letter of supports I mentioned earlier in previous messages. My surgery date is scheduled for September 21st as my doctor is of high demand and this is the first date available.

Any news on your status?

Best wishes

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AllisonK1986    68

AllisonK1986
Posted

Did u have to see ur pcp every month on top of already seeing the surgeon? Bc if that's true than I guess I'm screwed, bc no one from the insurance company or my surgeon office said I needed too.

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India928    81

India928
Posted

@@India928 we are bout to submit this week. So fingers crossed!

Best wishes! Praying for you!

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AllisonK1986    68

AllisonK1986
Posted

@@India928 on your policy did they clearly say that allowed bariatric surgery or that treatment for the morbidly obese was allowed if deemed medically necessary. Today the office manager submitted my papers and my gwh rep was giving the run around. So she ended up calling Cigna and submitting straight to them. I'm so stressed out right now bc it seems no one at gwh knows what's going on. When they told us several months ago it was all good!

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India928    81

India928
Posted

Allison,,,I believe it was clearly outlined as you mentioned. Praying for you!

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