I had my surgical consultation today for revision, but on the off chance that it is not deemed medically necessary for revision, I do qualify for bariatric surgery in general, repeating all of the requirements as if it were a new procedure. My question is regarding Cigna coverage. Most plans require a monitored 3, 6 or 12 month diet/nutrition/weight loss management through PCP or somewhere similar. Cigna's policy says NOTHING about this, only that "a statement from a physician other than the surgeon, that the individual has failed previous attempts to achieve and maintain weight loss by medical management" - it gives no other requirements or indicators. I called Cigna today to inquire and they couldn't tell me anything more about this.

So, for those of you that have been approved in the past few months (Cigna's policy requirements look to be effective 10/9/18 through 7/15/19), what did you provide for this? I have to have a letter from my primary anyway that recommends bariatric surgery. Would this be the same letter or separate? And what did you submit/have your PCP write to say that you had failed previous attempts? Thanks in advance for your help!

Edited March 4, 20197 yr by Add512

On ‎5‎/‎16‎/‎2019 at 8:03 PM, vovo2013 said:

Have your surgeon did a peer to peer review with Cigna? He has all the documents in order then he needs to the a peer to peer review! This will help lush your case forward.

Hey Vovo2013 - the young girl in the office told me, after I suggested that by next month, they just send the paperwork through and we'll let the "chips fall where they may"...she said the problem with that is if they 'deny' it than we have to do this 'peer review' with Cigna which slows things down and makes them very difficult. Honestly, and I do NOT say this to be unkind, but that young woman is very new, does not grasp terminology easily, is very very defensive...borderline hostile the last time I went in. I HATE this. I never wanted to hurt her or cause her distress, but I sincerely think she is in the WRONG position. Her badge says 'med tech', but I know she helps the office mgr do insurance verifications. She is truly out of her element and I wish for her own sake that she finds her niche.

I also do not like being treated in an obvious frosty manner as it made the whole visit feel so very painful. It's not just insurance she has an issue with...she called today asking when I was going to get my bloodwork done. I told her, I told Dr Dyslin @ my appt on Tuesday (Tuesday of last week), that I had gone to Quest on the previous Friday and he wrote that down. He also asked for my cardiologists name as they were going to reach out to him. So when she asked about my bloodwork, I told her I guess the Dr. forgot to tell her but I had it done 2 Fridays ago. She then asked, well, do you still need to go? I mean...there is just something off/wrong about her responses to my replies. I told her which Quest location it was..and asked if I needed to call or did they.

She said she'd call and then turned around & asked who I used for a cardiologist. I told her I gave the info to Dr. Dyslin but was happy to give it to her as well (FYI - it is on my new patient paperwork I filled out 2 months ago as well, I listed ALL doctors I saw, what for, and their contact info, Another odd response is when I was giving her the info she asked for on my cardiologist as I gave her the #, she said oh yeah, Dr. XXXX in Lewisville, yeah, I called and reached out to see if they need to clear you for surgery & they haven't called back. WHY ask me WHO my cardiologist is and then ask for his # so she can call and talk to him..when she has already done so? She didn't say "I've called your cardio and we aren't hearing back so can you call"...it was like she had no recollection of calling him @ first and not until I was giving her that she popped up with "oh, I called him".

Sorry, things like this make me cringe when she calls...it's like there is a huge information/communication disconnect.

:( :( :(

On ‎5‎/‎16‎/‎2019 at 8:21 PM, Add512 said:

I had surgery Monday. This particular plan through Cigna does not require any time period of medically managed visits for nutrition or weight loss and is accurate per the page I posted. I was approved first go within 3 days.

CONGRATS!!!! So very happy for you!! Have you posted on another thread as to how it went, how you're doing, etc. You've been on my mind a lot lately. As I drug our infamous 0051 coverage plan into my surgeon, I mentioned on how a woman in a completely different state with the SAME plan had also had her dr's office given the same /similar misleading responses but in the end, y'all pushed the paperwork through and you were approved!!

I have appt w/cardio hopefully by end of this month to get a chemical stress test to get clearance. Hopefully I will have all "loose ends" taken care of and ready to submit after I see surgeon again @ the first of next month. CROSS FINGERS!!

BOOM BABY! I got approve for my Gastro Bypass Surgery! From start to finish 3 weeks and surgery is schedule in August 2019. I had everything ready to go BEFORE I ever met my surgeon.

I only needed a Gastro Empty Test, Ultrasound, 24 hour Ph test and a sleep study! (all this was diagnose imagining scan.)

22 hours ago, vovo2013 said:

BOOM BABY! I got approve for my Gastro Bypass Surgery! From start to finish 3 weeks and surgery is schedule in August 2019. I had everything ready to go BEFORE I ever met my surgeon.

I only needed a Gastro Empty Test, Ultrasound, 24 hour Ph test and a sleep study! (all this was diagnose imagining scan.)

CONGRATS vovo2013!! That was QUICK approval. Out of curiosity, is surgery in August something you desired or is your dr that booked? Just wondering as I got my letter of approval from CIGNA 2 days ago!! HAH! Should have leaned harder on my dr's office to push stuff through instead of just telling me I didn't know what I was talking about and I shouldn't 'interfere' as it was delaying things. Hhhmm...I call Cigna for the THIRD time after you tell me once again that 'the process with take an ADDITIONAL six months'..and they are so frustrated with YOU that they call your office personally and explain to the office manager that they agree with me that I've met all the requirements so send the paperwork already!? And guess what, yep, they approved me.

I love the dr i'm working with so am torn about mentioning how 'unpleasant' it has been to feel like I have to fight some of his staff. I'm just relieved to be approved. Spouse just seems freaked out and concerned that I should not be doing this. His opinion will never change on this. I've been considering this for many years now and feel I have made a well though out decision that is the best for where I am at and where I need to be.

CONGRATS vovo2013!! That was QUICK approval. Out of curiosity, is surgery in August something you desired or is your dr that booked? Just wondering as I got my letter of approval from CIGNA 2 days ago!! HAH! Should have leaned harder on my dr's office to push stuff through instead of just telling me I didn't know what I was talking about and I shouldn't 'interfere' as it was delaying things. Hhhmm...I call Cigna for the THIRD time after you tell me once again that 'the process with take an ADDITIONAL six months'..and they are so frustrated with YOU that they call your office personally and explain to the office manager that they agree with me that I've met all the requirements so send the paperwork already!? And guess what, yep, they approved me.
I love the dr i'm working with so am torn about mentioning how 'unpleasant' it has been to feel like I have to fight some of his staff. I'm just relieved to be approved. Spouse just seems freaked out and concerned that I should not be doing this. His opinion will never change on this. I've been considering this for many years now and feel I have made a well though out decision that is the best for where I am at and where I need to be.

I personally pick August 2019 because I will be out of the country all of July 2019. During my surgeon hunt, I had Mcdreamy office staff treat me like that but the surgeon was amazing. I was like hell no, I will not be treated like this and look for somebody else. Plus, I found out were Mcdreamy was going to preform the surgery at a hospital that was out of network with my insurance. So, that was another reason why I did not go with Mcdreamy office. Yes, he was super cute and oh man... so good looking! I memorized the who baratric guidelines for Cigna and got most of my appointment done before I even met my surgeon. So, I had a quick approval from Cigna.

Sent from my SM-G973U using BariatricPal mobile app

17 minutes ago, vovo2013 said:

I personally pick August 2019 because I will be out of the country all of July 2019. During my surgeon hunt, I had Mcdreamy office staff treat me like that but the surgeon was amazing. I was like hell no, I will not be treated like this and look for somebody else. Plus, I found out were Mcdreamy was going to preform the surgery at a hospital that was out of network with my insurance. So, that was another reason why I did not go with Mcdreamy office. Yes, he was super cute and oh man... so good looking! I memorized the who baratric guidelines for Cigna and got most of my appointment done before I even met my surgeon. So, I had a quick approval from Cigna.

Sent from my SM-G973U using BariatricPal mobile app

I totally get the date now. My MIL is taking whole family on a cruise at Christmas (she's going to be 90), it's something she's always wanted to do and has the money to do so...we need to pay for airfare...which is actually more expensive than the cruise..LOL..but we want her to have everyone she wants with her so we are just glad to go. It's like a 50% vacation discount but the memories are priceless.

I'm wanting to be as HEALED as possible before the ship leaves the US. Am hoping I can get enough off to be able to do some snorkeling and for that I need to be able to climb up a boat ladder, etc. etc. CROSSING FINGERS! I meet with my dr next week and guess that is when we'll be planning the date. It truly has been one SPECIFIC person in his office, his office manager was never that specifically rude to me..and she never griped at me for calling my own insurance.

LOL about Mcdreamy...my dr is a nice looking man, but not @ that level. It is his skill with higher risk cases that has me determined to have him as my surgeon. I think I'll wait until after surgery, to give some positive and constructive feedback. My goal is to never be mean to anyone..so I need to wait and not discuss it in the 'heat of emotions'. However, the one lady could EASILY chase off patients from his practice. She made it clear at the last visit I had that she was NOT happy to be having to take my vitals. I just ignored it. If he wasn't worth the extra hassle, I WOULD have totally bailed...that is for sure! He also is one of the FEW that operates at the hospital that CIGNA prefers and is a 'bariatric center of excellence'..so that part worked in my favor...FINALLY..

On 3/4/2019 at 1:06 PM, Add512 said:

I had my surgical consultation today for revision, but on the off chance that it is not deemed medically necessary for revision, I do qualify for bariatric surgery in general, repeating all of the requirements as if it were a new procedure. My question is regarding Cigna coverage. Most plans require a monitored 3, 6 or 12 month diet/nutrition/weight loss management through PCP or somewhere similar. Cigna's policy says NOTHING about this, only that "a statement from a physician other than the surgeon, that the individual has failed previous attempts to achieve and maintain weight loss by medical management" - it gives no other requirements or indicators. I called Cigna today to inquire and they couldn't tell me anything more about this.

So, for those of you that have been approved in the past few months (Cigna's policy requirements look to be effective 10/9/18 through 7/15/19), what did you provide for this? I have to have a letter from my primary anyway that recommends bariatric surgery. Would this be the same letter or separate? And what did you submit/have your PCP write to say that you had failed previous attempts? Thanks in advance for your help!

im in California and have cigna. I was approved in 2 weeks. Would have been 3-days but see #1.

1. make sure the pcp sends a formal recommendation letter. this was the only thing that held me up. Cigna wanted it in a formal letter head.

2. the surgeon office confirmed the pre -stuff for me. Cigna required me to do 4 nutrition visits, psych eval, support group, formal recommendation from PCP, BMI requirements (listed in your post), co-morbidity (listed in your post).

3. my surgeon also has his own requirements

Edited October 29, 20196 yr by Chardonnay40