CIGNA DENIED

[Tiredmimi 57]

I am feeling pretty hopeless right now because Cigna denied my precertification for surgery. I am so totally shocked. Even though I meet the requirements which is BMI 35-40, 1 Comorbidity, and a letter from my PCP they denied it. My BMI fluctuates between 35-39 and I have hypertension which is what they list as requirements. I got on chat with a Cigna rep who looked into why and it says not medically appropriate due BMI. I don't get it. I have left a message for the lady handling my insurance at the surgeon's office to see what I can do. I know I don't have as high of a BMI as some people but it did fall under their guidelines. I don't know how they could have denied it! Anyone with any ideas?

[BadWolfGirl 245]

I am feeling pretty hopeless right now because Cigna denied my precertification for surgery. I am so totally shocked. Even though I meet the requirements which is BMI 35-40, 1 Comorbidity, and a letter from my PCP they denied it. My BMI fluctuates between 35-39 and I have hypertension which is what they list as requirements. I got on chat with a Cigna rep who looked into why and it says not medically appropriate due BMI. I don't get it. I have left a message for the lady handling my insurance at the surgeon's office to see what I can do. I know I don't have as high of a BMI as some people but it did fall under their guidelines. I don't know how they could have denied it! Anyone with any ideas?

Ugh I'm so sorry you're going through this. I hope you get it figured out soon.

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[catwoman7 10,922]

This happens sometimes - and sometimes you'll win on appeal. See what the surgeon's office has to say - I'm sure they've dealt with this before and can tell you how to proceed.

[Tiredmimi 57]

Thanks!

[New&Improved 1,780]

Most places need 2 or more comorbidities if under 40 BMI..

Ask your surgeon to adjust the paperwork

[Tiredmimi 57]

I am going to hopefully speak with them tomorrow! My Cigna plans requirements clearly state BMI of 35-40 and 1 or more comorbidities. When I did my surgical consult hos nurse said oh you will get approved so I was pretty hopeful until today!

[New&Improved 1,780]

My comorbidities were diabetes. High blood pressure. Cholesterol issues. Others have sleep apnea.

Yeah have a good chat with Dr make him resubmit a better letter

[Tiredmimi 57]

I realize that a lot of people have higher BMI's than me. I turned 60 this year which almost makes me feel if when the insurance receives these pre-certs if that plays into their decision. I feel my age might be used against me here but idk. The thing is both of my parents died in their 60's due to complications of diabetes. They both had heart disease and heart surgery. They had many different illnesses and I have been fortunate so far as far as that goes. I just want to make a positive change now before it is too late!

[catwoman7 10,922]

3 minutes ago, Tiredmimi said:

I realize that a lot of people have higher BMI's than me. I turned 60 this year which almost makes me feel if when the insurance receives these pre-certs if that plays into their decision. I feel my age might be used against me here but idk. The thing is both of my parents died in their 60's due to complications of diabetes. They both had heart disease and heart surgery. They had many different illnesses and I have been fortunate so far as far as that goes. I just want to make a positive change now before it is too late!

I had surgery when I was 55. Several people have had it in their 60's. The only person I know who wasn't accepted due to age was 78 (and he very well could have had other issues at well that affected the decision), so I think you're OK!

[Puffy-no-more 141]

Also, check your medical records and make sure your measurements are correct. Not in relation to WLS but I had an issue one time with a nurse putting info in wrong and it showed that my BMI was a lot lower than what it actually was cause she had made me taller on paper. 😬

[_xoASculpts 1]

Sorry to hear about that. If you meet the requirements, I don’t see why they denied you. Apparently something as small as your medical clearance letter can lead to a denial. I was told to make sure the clearance letter from my physician specifically stated that I am medically cleared for the procedure and that it is medically necessary due to my hypertension. Another issue I’ve heard is that while Cigna covers the procedure, sometimes the employer excludes bariatric surgery.

I also have Cigna with a BMI of 35 even and was approved in one day. I was given a checklist of what I needed to submit for approval and can share if you’re interested. Good luck!

[Losingit2018 1,170]

3 hours ago, Tiredmimi said:

I am feeling pretty hopeless right now because Cigna denied my precertification for surgery. I am so totally shocked. Even though I meet the requirements which is BMI 35-40, 1 Comorbidity, and a letter from my PCP they denied it. My BMI fluctuates between 35-39 and I have hypertension which is what they list as requirements. I got on chat with a Cigna rep who looked into why and it says not medically appropriate due BMI. I don't get it. I have left a message for the lady handling my insurance at the surgeon's office to see what I can do. I know I don't have as high of a BMI as some people but it did fall under their guidelines. I don't know how they could have denied it! Anyone with any ideas?

I think that they are just putting you through your paces. Have your dr appeal the denial. Hang in there because I really think that you will get approved.
please keep us posted.

[Losingit2018 1,170]

2 hours ago, Tiredmimi said:

I am going to hopefully speak with them tomorrow! My Cigna plans requirements clearly state BMI of 35-40 and 1 or more comorbidities. When I did my surgical consult hos nurse said oh you will get approved so I was pretty hopeful until today!

Do t give up. Some insurance companies just put you through your paces to get the benefits that you are entitled to. Someone has overlooked something.

[GradyCat 3,692]

You're entitled to at least one appeal, so appeal it and provide more medical evidence for the necessity and see what happens. Good luck.

[JRT Mom 919]

I've not used them, but I've heard people get great results from a law firm out west called Lindstrom Obesity Advocates. If you google the name you can find their website, and the first consultation is free.

I agree with Puffy-no-more...check your height. I was 5'4" my whole life, but the office measured my height recently and now I'm 5'3", and just that one inch put my BMI into the range that Medicare covered!