Cigna question

Bethanyblondie · May 21, 2008

Hello! I am new here and I have a PCP appt. tomorrow to talk about the lap band. I have read Cigna's most recently revised requirements for WLS and I am wondering about the BMI of 40 for 24 months "proof." I haven't been great about going to the doctor for check ups since I moved out on my own many years ago. I did go to a weight loss center (Slim4Life) starting in April 2005 and weighed 255 at the time, which would definitely put me past a 40 BMI. But then my weight has gone down and up a lot during that time and I also was pregnant and had a baby.

I did go to the doctor, I think, around Nov. 2005 because I felt like crap all of the time. He tried to tell me he thought I was depressed and offered me antidepressants, which I refused. At that time I had lost 40 pounds on my program...so my BMI would not have been as high.

So does anyone know if I had to be a constant 40 BMI for the last 24 months to qualify for insurance coverage on this procedure? I do not have any health issues that would qualify as a co-morbidity, so I probably can't put myself in 35-39.9 BMI with a co-moribidity issue.

Just curious if anyone has had that same issue. I am currently trying to get my records from my weight loss center from 2 years ago, but they don't have them in their current files so they are trying to track them down. They said there is a possibility that they were destroyed since I haven't been back since April 2006.

Any advice or help would be appreciated. This whole process is pretty intimidating...but I am willing to fight the fight to get the help I need!

Thanks!

cathychatts · May 21, 2008

Bethany

I also have Cigna and I can tell you that your BMI can go up and down, mine did. Acutally it complies with what their reasoning is, that you can loose, but gain back and more. The yo-yo is a plus to get approved. I just found records that gave my weight high at times over a 5 year period, all they require is 2 years. I also had the 6 months with different programs, but found 6 consecutive months.

Good Luck!

Bethanyblondie · May 21, 2008

Did your weight records have to be as recorded by a physician? I did Slim4Life on my own...not supervised by a PCP or anything. I mean...they are certified nutritionists...does that count? They would have the only recorded records with the exception of my one doctor's appt. I don't figure I can use any of my weight recordings from my pregnancy...which I started out my pregnancy about 220 and maxed out at 257.

Did you still have to a physician guided diet for six months? If Slim4Life can find my records (keep your fingers crossed!), do you think my year with them would count?

Bethanyblondie · May 21, 2008

Well, Slim$Life has informed me that they shredded my records because they don't keep files that are more than two years old...which means they probably got destroyed just a few weeks ago. So this means I don't have any formal records of my year of weight loss with them. I am looking around for my own file with my food journals and program outline...I think I might still have it somewhere.

If I can't find that, would my bank records showing my payments to Slim4Life count as anything? Or my records of paying for gym memberships or Weight Watchers or anything?

Who the heck keeps around two years of PROOF that you are fat? Grrr... :rolleyes:

Bethanyblondie · May 25, 2008

Does anyone know if bank records of paying for a weight loss program counts as proof of following one for six + months? I went to Slim4Life in 2005-2006, but had to quit due to becoming pregnant. I just called them to see if they still had my records anywhere and they have been shredded to protect my private information. But I CAN track down all of my credit card and bank statements showing that I consistently went there for a year.

Will that work?

Oh, and if I don't have a lot of documented proof of my weight from the last two years...do you think if I submit a self made porfolio with pics and my own chronicling of my weight and weight loss attempts that might be enough? I'd sure like to get on with this and not have to wait six months before I can get this done!

wsw27 · May 25, 2008

You mentioned that you had a baby, you should get records from your ob/gyn. See what those records show. I have CIGNA too and am about to submit for approval. A surgeon's office will be able to help you navigate through the insurance process. Good luck.

Bethanyblondie · May 25, 2008

Thanks. i didn't know if my weight while I was pregnant would count...but I got up to almost 260 while pregnant, and I only gained about 30 pounds..so I was up there when I got pregnant as well.

I hope you get your approval! I sure would like to get mine in the next couple of months instead of having to wait six more months!

wsw27 · May 25, 2008

Your weight while pregnant probably won't count, but your weight after you had the baby should. Also if you had annual check ups, the ob/gyn generally records your weight and blood pressure etc. Just another potential source for records. good luck

sweet2bme · May 26, 2008

I am glad you posted your question. I have a similar situation since I haven't had a pcp since moving out of town for college and i usually go to the emergency room when I get too sick( I know not the wisest thing for a college student on a budget to do). Hopefully, someone will be able to help! I actually called the insurance specialist at my surgeon's office. She said she would call me back but that was 3 days ago. Go figure:(