Jump to content
×
Are you looking for the BariatricPal Store? Go now!

Cigna- Requirements and Timeline



Recommended Posts

Hi!

I'm looking at getting DS. I am currently in the process of finding a surgeon/WLS program.

I am trying to find out if anyone here has gone thru the process of getting Cigna to cover their surgery since the beginning of 2019 (from what I can tell there was a policy change but I'm not sure what that change entails). What kind of waiting period did you have to go thru? Other requirements?

I'm *hoping* to be able to get my surgery done by the end of July- my Cigna insurance runs out then due to me turning 26.

Any input/insight would be appreciated.

Thank you!

Edited by PeaceDove24

Share this post


Link to post
Share on other sites

I'd contact Cigna directly and ask about their requirements. It is almost June, and many insurers have a 3-6 month waiting period where you need to be having monthly dietitian and nutrition visits. I imagine You'll need a psych evaluation, cardiac clearance, etc. Getting it done by the end of July will be tough, I think. But good luck. I initially wanted DS, but my surgeon and his group do not perform it.

Sent from my SM-N960U using BariatricPal mobile app

Share this post


Link to post
Share on other sites

1 hour ago, Briswife15 said:

I'd contact Cigna directly and ask about their requirements. It is almost June, and many insurers have a 3-6 month waiting period where you need to be having monthly dietitian and nutrition visits. I imagine You'll need a psych evaluation, cardiac clearance, etc. Getting it done by the end of July will be tough, I think. But good luck. I initially wanted DS, but my surgeon and his group do not perform it.

Sent from my SM-N960U using BariatricPal mobile app

I called Cigna this past Friday (5/17) morning to ask, the lady I talked to was very confused when I asked if there was a required waiting period and on the sheet she sent me (below hopefully) it doesn't say anything about a required waiting period- just that I have to have a Doc sign off that I haven't had success losing weight in the past and have done a Nutrition eval, psych eval, and gotten clearance from my PCP in the past 6 months.

Thankfully I'm not attached to a single surgeon- I can go to any surgeon I want that is In-Network and thinks I'm qualified (and has the availability to do it within my time frame).

Bariatric Surgery.pdf

Share this post


Link to post
Share on other sites

I read through that...it sounds encouraging! No monthly nutritionist visits, which is usually what slows people down. Hoping you get it done in your time frame! Best to you!!

Sent from my SM-N960U using BariatricPal mobile app

Share this post


Link to post
Share on other sites

15 hours ago, PeaceDove24 said:

Hi!

I'm looking at getting DS. I am currently in the process of finding a surgeon/WLS program.

I am trying to find out if anyone here has gone thru the process of getting Cigna to cover their surgery since the beginning of 2019 (from what I can tell there was a policy change but I'm not sure what that change entails). What kind of waiting period did you have to go thru? Other requirements?

I'm *hoping* to be able to get my surgery done by the end of July- my Cigna insurance runs out then due to me turning 26.

Any input/insight would be appreciated.

Thank you!

Hey there! I just got approved by Cigna this week! Their requirements are: a recommendation from a nutritionist, a psych recommendation, a recommendation from the surgeon, and a recommendation from a physician who is not the surgeon nor is affiliated with the surgeon (my PCP provided this). Cigna does not have specific requirements for a medically-supervised diet, and I did not do one. That said, I have heard of PCPs/surgeons not giving you a recommendation until you meet a requirement that they have, but Cigna does not have a physician-supervised diet requirement as of right now. As soon as my surgeon’s office received those 4 things, it was sent off and my surgery was approved within 4 days. The whole process took a few weeks but only because of my schedule and having to move appointments around. I hope that helps!! Good luck!

Share this post


Link to post
Share on other sites

13 minutes ago, LessFee said:

Hey there! I just got approved by Cigna this week! Their requirements are: a recommendation from a nutritionist, a psych recommendation, a recommendation from the surgeon, and a recommendation from a physician who is not the surgeon nor is affiliated with the surgeon (my PCP provided this). Cigna does not have specific requirements for a medically-supervised diet, and I did not do one. That said, I have heard of PCPs/surgeons not giving you a recommendation until you meet a requirement that they have, but Cigna does not have a physician-supervised diet requirement as of right now. As soon as my surgeon’s office received those 4 things, it was sent off and my surgery was approved within 4 days. The whole process took a few weeks but only because of my schedule and having to move appointments around. I hope that helps!! Good luck!

This is AWESOME to hear. Hopefully the PCP I meet with tomorrow (new PCP I'm "interviewing" to find a new one) can give me that physician-recommendation. But I wonder, if it could come from my Endocrinologist. I know she said she couldn't do a referral for insurance, but if it's just a recommendation letter....

Now I just have to find a surgeon that is in network and doesn't require a supervised diet/classes.

Can I ask what surgeon you're using?

Share this post


Link to post
Share on other sites

17 minutes ago, othella2 said:

Did they say you has to do the 6 Month weight loss before??

Sent from my Moto E (4) using BariatricPal mobile app

I've never asked about it directly to them before. I am pretty sure I looked up requirement several years ago and there was a 6 month stipulation. But there is not one now.

Share this post


Link to post
Share on other sites

I've never asked about it directly to them before. I am pretty sure I looked up requirement several years ago and there was a 6 month stipulation. But there is not one now.
You should call the insurance directly. I called mine often to make sure I had everything right. It's easier to get through to the insurance if you call in the morning.

Sent from my Moto E (4) using BariatricPal mobile app

Share this post


Link to post
Share on other sites

10 minutes ago, othella2 said:

You should call the insurance directly. I called mine often to make sure I had everything right. It's easier to get through to the insurance if you call in the morning.

Sent from my Moto E (4) using BariatricPal mobile app

I called them this past Friday at ~8am. Got thru relatively easily. The issue is that they couldn't find any actual requirements related to a waiting period.

Share this post


Link to post
Share on other sites

2 hours ago, PeaceDove24 said:

This is AWESOME to hear. Hopefully the PCP I meet with tomorrow (new PCP I'm "interviewing" to find a new one) can give me that physician-recommendation. But I wonder, if it could come from my Endocrinologist. I know she said she couldn't do a referral for insurance, but if it's just a recommendation letter....

Now I just have to find a surgeon that is in network and doesn't require a supervised diet/classes.

Can I ask what surgeon you're using?

I’m in Dallas, and I’m using Dr. Jeffrey Henke. His office is great. Before your appointment with him, they send you a copy of the requirements for surgery that are specific to your insurance. I had the psych appointment booked before I even saw him.

Share this post


Link to post
Share on other sites

2 hours ago, othella2 said:

Did they say you has to do the 6 Month weight loss before??

Sent from my Moto E (4) using BariatricPal mobile app

Nope. Cigna only has those 4 requirements that I mentioned above. There is no 6-month requirement or medically-supervised diet requirement of any kind at this time. The current requirements are good through July, so it may change after that. But for now, I was approved submitting the 4 items I listed above per Cigna’s current policy.

Share this post


Link to post
Share on other sites

On 5/19/2019 at 6:46 PM, LessFee said:

Nope. Cigna only has those 4 requirements that I mentioned above. There is no 6-month requirement or medically-supervised diet requirement of any kind at this time. The current requirements are good through July, so it may change after that. But for now, I was approved submitting the 4 items I listed above per Cigna’s current policy.

This is so crazy. I'm trying to get the DS, so can't go with Henke since he doesn't do that- but I just talked to another Dallas/Fort Worth surgical center that told me (before verifying insurance) that Cigna has a 1 month diet requirement.

I'm just like. Y'all. Get your stories straight?

Share this post


Link to post
Share on other sites

I have Cigna and I was under the impression that the DS surgery is not covered by Cigna at this time (or wasn’t last year when I had the sleeve).


Sent from my iPhone using Tapatalk

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now

  • Trending Products

  • Trending Topics

  • Recent Status Updates

    • Prdgrdma

      So I guess after gastric bypass surgery, I cant eat flock chips because they are fried???  They sell them on here so I thought I could have them. So high in protein and no carbs.  They don't bother me at all.  Help. 
      · 1 reply
      1. NickelChip

        It's possible for a very high fat meal to cause dumping in some (30% or so) gastric bypass patients, although it's more likely to be triggered by high sugar, or by the high fat/high sugar combo (think ice cream, donuts). Dietitians will tell you to never do anything that isn't 100% healthy ever again. Realistically, you should aim for a good balance of protein, carbs, and fat each day. Should you eat fried foods every day? No. Is it possible they will make you sick? Maybe. Is it okay to eat some to see what happens and have them for a treat every now and again? Yes.

    • NovelTee

      I'm not at all hungry on this liquid pre-op diet, but I miss the sensation of chewing. It's been about two weeks––surgery is in two days––and I can't imagine how I'll feel a couple of weeks post-op. Tonight, I randomly stumbled upon a mukbang channel on YouTube, and it was strangely soothing... is it just me, or is this a thing? 
      · 1 reply
      1. NickelChip

        I actually watched cooking shows during my pre-op, like Great British Baking Show. It was a little bizarre, but didn't make me hungry. I think it was also soothing in a way.

    • Clueless_girl

      How do you figure out what your ideal weight should be? I've had a figure in my head for years, but after 3 mths of recovery I'm already almost there. So maybe my goal should be lower?
      · 2 replies
      1. NickelChip

        Well, there is actually a formula for "Ideal Body Weight" and you can use a calculator to figure it out for you. This one also does an adjusted weight for a person who starts out overweight or obese. https://www.mdcalc.com/calc/68/ideal-body-weight-adjusted-body-weight

        I would use that as a starting point, and then just see how you feel as you lose. How you look and feel is more important than a number.

      2. Clueless_girl

        I did find different calculators but I couldn't find any that accounted for body frame. But you're right, it is just a number. It was just disheartening to see that although I lost 60% of my excess weight, it's still not in the "normal/healthy" range..

    • Aunty Mamo

      Tomorrow marks two weeks since surgery day and while I'm feeling remarkably well and going about just about every normal activity, I did wind up with a surface abscess on on of my incision sights and was put on an antibiotic that made me so impacted that it took me more than two hours to eliminate yesterday and scared the hell out of me. Now there's Miralax in all my beverages that aren't Smooth Move tea. I cannot experience that again. I shouldn't have to take Ativan to go to the lady's. I really looking forward to my body getting with the program again. 
      I'm in day three of the "puree" stage of eating and despite the strange textures, all of the savory flavors seem decadent. 
      I timed this surgery so that I'd be recovering during my spring break. That was a good plan. Today is a state holiday and the final day of break. I feel really strong to return to school tomorrow. 
      · 0 replies
      1. This update has no replies.
    • BeanitoDiego

      Now that I'm in maintenance mode, I'm getting a into a routine for my meals. Every day, I start out with 8-16 ounces of water, and then a proffee, which I have come to look forward to even the night before. My proffees are simply a black coffee with a protein powder added. There are three products that I cycle through: Premier Vanilla, Orgain Vanilla, and Dymatize Vanilla.
      For second breakfast on workdays, I will have a low-fat yogurt with two tablespoons of PBFit and two teaspoons of no sugar added dried cherries. I will have ingested 35-45 grams of protein at this point between the two breakfasts, with 250-285 calories, and about 20 carbs.
      For second breakfast on non-workdays, I will prepare two servings of plain, instant oatmeal with a tablespoon of an olive oil-based spread. This means I will have had 34 grams of protein, 365 calories, and 38 carbs. Non-workdays are when I am being very active with training sessions, so I allow myself more carbohydrate fuel.
      Snacks on any day are always mixed nuts, even when I am travelling. I will have 0.2 cups of a blend that I make myself. It consists of dry roasted peanuts, cashews, pumpkin seeds, sunflower seeds, pistachios, and Brazil nuts. This is 5 grams of protein, 163 calories, and 7 carbs.
      Breakfast and snacks have been the easiest to nail down. Lunch and dinner have more variables, and I prepare enough for leftovers. I concentrate on protein first, and then add vegetables. Typically tempeh, tofu, or Field Roast products with roasted or sautéed vegetables. Today, I will be eating leftovers from last night. Two ounces of tempeh with four ounces of roasted vegetables that consist of red and yellow sweet peppers, sweet potatoes, small purple potatoes, zucchini, and carrots. I will add a tablespoon of olive oil-based spread, break up 3 walnuts to sprinkle of top, and garnish with two tablespoons of grated Parmesan cheese. This particular meal will be 19 grams of protein, 377 calories, and 28 grams of carbs. Bear in mind that I do eat more carbs when I am not working, and I focus on ingesting healthy carbs instead of breads/crackers/chips/crisps.
      It's a helluva journey and I'm thankful to be on it!
       
      · 0 replies
      1. This update has no replies.
  • Recent Topics

  • Hot Products

  • Sign Up For
    Our Newsletter

    Follow us for the latest news
    and special product offers!
  • Together, we have lost...
      lbs

    PatchAid Vitamin Patches

    ×