Cigna Denial

[AmyML 7]

Hi! I'm new here but I have been on my journey to get approved for WLS since May.

My Doctor's office submitted all my paperwork on 09/11/15 and I just got the call today that Cigna denied it, they said that it was denied stating I didn't complete my 90 days of supervised nutrition.

I went through a registered dieticianand had my first meeting with her on 05/16/15 where we discussed healthy eating, exercise, and took my weight. She sent me a meal nutrition plan and I started on my merry way, I saw her again on 06/18/15, 07/31/15, and 08/22/15 in which we discussed the same thing and she went over what I had been eating, my exercise along with taking my weight.

I figured I was ok but they are stating that the first visit didn't count and now I have to go back again after 09/16/15 for another visit. On top of that they are saying they also want the paper work from the surgeon from his final surgery counsulation visit that I have on the 24th. (As far as I knew they only needed 90 days nutrition, letter from PCP, letter from metal health provider, and letter from surgeon all recommending I was a good canidiate for surgery) so I'm not sure why they require even more from the surgeon as he already submitted his paperwork with the proposed surgery information.

Anyway I'm REALLY hoping they don't deny me again once I get another weigh in done with my dietition which I have on 09/19/15, my heart really sank when I heard I was denied especially since I've already gone through all the medical clearance for surgery preperation i.e. labwork, EKG, ect.

Just figured I would post my experience so far as I had called Cigna at least 3-4 times asking them if my first visit with the dietician would count and they had originally said yes.

Edited September 15, 2015 by AmyML

[Daisee68 2,493]

I am so sorry that happened! It seems to have happened to someone else here too but they accepted my first date. So strange. (Well let's see they counted my first visit on 1/30 and my last visit on 5/30 and 2 visits in between, so maybe they didn't actually... Hmmm now I am not sure.) Anyway, I know it is very disappointing, but I am sure that as soon as you submit the other 2 things later this month that they will approve you quickly. Hang in there!!

[NE_NevadaGrl 31]

I read the guidelines probably 100 times. It states no less than 89 days of PCP monitored dieting (or dietitian monitored). Was it the full 89 days?

[NE_NevadaGrl 31]

Cigna guidelines

[AmyML 7]

I read the guidelines probably 100 times. It states no less than 89 days of PCP monitored dieting (or dietitian monitored). Was it the full 89 days?

From May 16th it would have been over 90 days but since they didn't count that one saying it was just a consulation which I can't understand why because we went over everything that day and she documented my weight as well.

Also every time I called them as well which was at least 3-4 times or more they stated my first visit would count and I told them everything that was done at it, they really need to update that if it's not true. Heck I even kept a journal showing what I ate every single day and the exercise I did.

I'm still going to go to another dietician appointment because I don't want them to deny this last appeal before a peer to peer, I just wish they would say a first visit doesn't count and you need to go again right after.

Edited September 16, 2015 by AmyML

[newmebithebypass 713]

i work for a psych office and cigna is supper finicky the right hand doesnt know what the left hand is doing half the time sorry you got denied but cigna is super strict

[AmyML 7]

i work for a psych office and cigna is supper finicky the right hand doesnt know what the left hand is doing half the time sorry you got denied but cigna is super strict

That makes me feel more optimistic that they will approve me once I go for another dietician visit then! I have it for Saturday and then my final surgeon decision appointment next week then they can submit the appeal. I would assume if there was anything else causing issues of denial they would have said.

Thank you for the info!

[4MRB4PHOTO 3,899]

Been there, done that.

CIGNA did not approve my surgery (I found out 16 days before the surgery, on a Saturday) due to:

1) Not being on a doctors supervised diet for 3 months (they were paying for a nutritionist for over 5 months at that point, along with visits to nurses and a doctor).

2) My PCP did not approve the surgery (she recommended me to consider this surgery more than 2 years earlier).

I contacted my PCP and the surgeon and had both be advocates for me, they contacted CIGNA, resubmitted the forms and magically they now approved it.

Contact your doctor and have them contact CIGNA. Good luck.

[AmyML 7]

Been there, done that.

CIGNA did not approve my surgery (I found out 16 days before the surgery, on a Saturday) due to:

1) Not being on a doctors supervised diet for 3 months (they were paying for a nutritionist for over 5 months at that point, along with visits to nurses and a doctor).

2) My PCP did not approve the surgery (she recommended me to consider this surgery more than 2 years earlier).

I contacted my PCP and the surgeon and had both be advocates for me, they contacted CIGNA, resubmitted the forms and magically they now approved it.

Contact your doctor and have them contact CIGNA. Good luck.

I spoke with my doctors office and she told me it's best if I just do another dietician visit to ensure it's not denied again. I'm ok with it as it's only a couple days away instead of having to wait a full month or even worse starting all over again. Just a tad stressful to wait again for an answer.

Your situation sounded like it was even worse, so glad to hear they approved you in the end!

Edited September 16, 2015 by AmyML

[AmyML 7]

Just got the call today that my surgery was approved!!

I went back to my dietician for a 4th weigh in 09/29/15 had her fax my doctors office right away, went to my final surgeon visit on 09/24/15 and they added a letter of advicacy along with a procedure code and extra letter from the surgeon which was faxed to Cigna 09/28/15.

I had gained some weight on the 90 day nutrition but that didn't cause any issues, my surgery date is set for October 26th so I'm really excited now!