Cigna Approval

[LLG1981 47]

Hi All,

I am new to the group and just finished all of my necessary requirements and was wondering if anyone with Cigna insurance can tell me how long it took for an approval? My surgeons office is submitting all of the paperwork tomorrow and I am hoping for a quick approval so I can get scheduled as soon as possible. Thank you!

[LLG1981 47]

Update: I reached out to cigna on Friday to confirm they received everything and they confirmed they did and I was currently pending and I should have an answer in 3-5 business days. I will check back on Friday if I don't hear back.

[KarenLR75 518]

Am particularly interested in your results with Cigna as I also have Cigna. Do you know what type of 'pre-op' weight loss hoops you have to jump through? For example, how long do you have to be on a supervised pre-op weight loss program, etc.

Fingers crossed for you!1

[LLG1981 47]

Thanks KarenLR75. They require a BMI of over 40 or 35 with a co-morborbidy. That is the first requirement. If you meet any of those two then you will need:

A letter of necessity/recommendation from my PCP with full blood work

4 Nutri. visits that will also include discussion about an exercise program that are consecutive and need to be over at least a 90 day period. I had mine in Oct, Nov, Dec, and Jan.

Mental Health Eval (mine was not covered so it was out of pocket)

Pulmonary clearance which included a sleep test (out of pocket)

Cardiac clearance with an EKG, ECO and stress test (out of pocket)

Endoscopy (out of pocket)

Ultrasound of the upper stomach to rule out issue with gal badder

All of these have to be completed before submission for approval and have to be done 6 months from your first consult with your bariatric surgeon. I started on August 23 and submitted last week, just shy of the 6 month mark. I could have completed it in Jan but since many of the big procedures had to be out of pocket to meet my deductible i moved them to the beginning of the new year to hit my deductible and my out of pocket max so I wouldn't be paying more than I had too.

[elforman 234]

1 hour ago, LLG1981 said:

Thanks KarenLR75. They require a BMI of over 40 or 35 with a co-morborbidy. That is the first requirement. If you meet any of those two then you will need:

A letter of necessity/recommendation from my PCP with full blood work

4 Nutri. visits that will also include discussion about an exercise program that are consecutive and need to be over at least a 90 day period. I had mine in Oct, Nov, Dec, and Jan.

Mental Health Eval (mine was not covered so it was out of pocket)

Pulmonary clearance which included a sleep test (out of pocket)

Cardiac clearance with an EKG, ECO and stress test (out of pocket)

Endoscopy (out of pocket)

Ultrasound of the upper stomach to rule out issue with gal badder

In my case everything you list as out of pocket is still covered by Cigna, they're just not included as part of the cost of the bariatric procedure. Everything is subject to the regular co-pays and deductibles, of course. I've got Cigna as well (Open Access PPO) and the only thing they don't cover is the psychiatric consult from the psychiatrist my surgeon recommended.

My surgeon told me the psych exam will cost $400 because and there are no psychiatrists in-network in the area who do this type of evaluation. Honestly, I'm not entirely sure about that and I will be calling Cigna to confirm that. Also, I can do it over the phone, which means I don't have to take any time off from work and drive who knows where, I might just go ahead and pay it.

[LLG1981 47]

In my case everything you list as out of pocket is still covered by Cigna, they're just not included as part of the cost of the bariatric procedure. Everything is subject to the regular co-pays and deductibles, of course. I've got Cigna as well (Open Access PPO) and the only thing they don't cover is the psychiatric consult from the psychiatrist my surgeon recommended.
My surgeon told me the psych exam will cost $400 because and there are no psychiatrists in-network in the area who do this type of evaluation. Honestly, I'm not entirely sure about that and I will be calling Cigna to confirm that. Also, I can do it over the phone, which means I don't have to take any time off from work and drive who knows where, I might just go ahead and pay it.

Yes that’s correct. I have open access plus ppo. They covered all those and I received the discounts and such but hadn’t met my deductible yet so it was an out of pocket expense for me. They fully covered the blood work, ultrasounds, nutritionist visits, and apt with my pcp (even without meeting deductible)

My psyche eval was also 400.

[KarenLR75 518]

13 hours ago, LLG1981 said:

Thanks KarenLR75. They require a BMI of over 40 or 35 with a co-morborbidy. That is the first requirement. If you meet any of those two then you will need:

A letter of necessity/recommendation from my PCP with full blood work

4 Nutri. visits that will also include discussion about an exercise program that are consecutive and need to be over at least a 90 day period. I had mine in Oct, Nov, Dec, and Jan.

Mental Health Eval (mine was not covered so it was out of pocket)

Pulmonary clearance which included a sleep test (out of pocket)

Cardiac clearance with an EKG, ECO and stress test (out of pocket)

Endoscopy (out of pocket)

Ultrasound of the upper stomach to rule out issue with gal badder

All of these have to be completed before submission for approval and have to be done 6 months from your first consult with your bariatric surgeon. I started on August 23 and submitted last week, just shy of the 6 month mark. I could have completed it in Jan but since many of the big procedures had to be out of pocket to meet my deductible i moved them to the beginning of the new year to hit my deductible and my out of pocket max so I wouldn't be paying more than I had too.

[KarenLR75 518]

• I've tried to respond 5 times and IE keep shutting down. Suffice to say I think someone noted that the clock started ticking after the first meeting with bariatric surgeon. I've been trying to get all of these other things out of the way while Ive been LOOKING for a surgeon. May have to rethink that.

Thanks to all!!

[LLG1981 47]

I wanted to provide an update that I have been approved! Paperwork was submitted on the 15th and approved this morning!

Just an FYI, I did received a letter yesterday, dated the day of my submission stating they received the preauthorization with a list of items needed to process the claim. This freaked me out but when I called my surgeons office and Cigna they let me know it is a standard letter informing me of the medical items needed for approval so I was aware and not a notification of missing items. They said it is something standard Cigna sends to alert their customers. Wanted to pass this along to anyone in case the same happens but I do also suggest calling to double check. All and all the process was quick and efficient.

[domi 237]

In my case everything you list as out of pocket is still covered by Cigna, they're just not included as part of the cost of the bariatric procedure. Everything is subject to the regular co-pays and deductibles, of course. I've got Cigna as well (Open Access PPO) and the only thing they don't cover is the psychiatric consult from the psychiatrist my surgeon recommended.
My surgeon told me the psych exam will cost $400 because and there are no psychiatrists in-network in the area who do this type of evaluation. Honestly, I'm not entirely sure about that and I will be calling Cigna to confirm that. Also, I can do it over the phone, which means I don't have to take any time off from work and drive who knows where, I might just go ahead and pay it.

Check and see if you have EAP benefits from your employer. They covered my psych visits.