I just received a letter from Cigna saying that they cant substantiate medical necessity for the lap band. It says that I need to send my clinicals to the insurance company for review. I now dont know what to do, I have no co-morbitualities or anything, and no I have had no tests, so I dont know what they are looking for. the last thing I had was an echo-cardiogram about 2 years ago. Any ideas???

When I was working on my insurance approval... the surgeons office knew what my plan needed for requirements. I too was able to access this from my insurance companies website, it is usually spelled out pretty clearly what is needed. In my case it was a letter from my primary care MD, 5 year weight record and weightloss attempts from the same records from my MD. An eval from a psychologist. They want documentation of weightloss attemps and such. It sounds to me the word "clinicals" means your medical records. I would try contacting Cigna and speak to someone specifically to find out. Another helpful thing is to talk to your human resources department and find out who the Cigna representative is for their insurance concerns, it is very helpful to have someone directly helping on the other end. Always get a name and extension number for future issues.

Good Luck, it takes time and work but its been worth it!! I went to my first seminar in August of 2007 and got approved at the end of January 2008!

Call and ask what they want. Make them spell it out and then get it.

It sounds like they need a letter from your PCP stating medical neccesity. Call the number on the back of your card and ask.

Thank you for the replys, I did everything so far required of me, from the 6 month nutritionist, to all of the tests and the letter of medical necessity, I will give them a call on tuesday to see what they want, I was also thinking they want my records, so hopefully my doctor will fax them over and I can move one more step forward to approval. thank you again.

Did you send the letter to Cigna or did you doctor? I know that my surgeon told me that after I did my 6 month required insurance diet, that they would send a letter to my insurance company. They told me of the requirements of the insurance company that was going to have to meet and that I had the 6 months to do it.

Lisa

I got a similar letter last week. They said I was denied because they didn't get my psych eval. You just need to contact your surgeon's office or whoever submitted your paperwork to the insurance company and have them contact the insurance. They will then submit whatever you are missing for you. I got an instant approval as soon as they received it. It does sound like Clinicals would either be your six month diet chart notes or your five year weight history.

My cigna required a psych eval, 6 months of supervised dieting, a letter from my primary dr stating he was approving me for surg. a personal typed history of my view of my diet history, and past three years of weight history. I also had to go to a doctor that was approved by Cigna. I called them and spoke with someone who guided my thru their website to get the criteria. I hope this helps.

Just FYI. Here is a link to Cigna's website showing their coverage position on bariatric surgery if your plan covers it. It shows exactly what their requirements are and what they do and do not cover.

http://www.cigna.com/customer_care/healthcare_professional/coverage_positions/medical/mm_0051_coveragepositioncriteria_bariatric_surgery.pdf

Hope this helps someone.