Hey there. My name is Megen and I have insurance through Cigna. I am in month 2 in the 6 month program, and I was just wondering what everyone submitted for insurance approval. I have read the criteria for the lapband several times, and called the 1-800 number a few times also, but I was wondering if I could hear some firsthand experiences with getting approved. I am tracking everything I eat for the 6 month program (although I haven’t lost any weight- actually gained 8lbs), I am tracking every time I work out, and I am making all the necessary appointments for the letters of medical necessary. Also, I am aware that CIGNA covers 90% of the cost for the lap band, but I also would like to know what the typical out-of-pocket cost was. Thanks!

Just make sure your 6 month program is through a nutritionist where their tracking your weight, progress and exercise. You won't get submitted until your last visit with a nutritionist. Make sure included in there is a consultation with a nutritionist and then an additional 6 after that. After you finish number 6 you will then be submitted. Expect a couple bumps in the road. Cigna sometimes says they don't receive all the information, which you then need to be resubmitted. Once your resubmitted, expect your wait time to be about 30 days. It's a long progress. It will come quicker then you think!!

I submitted:

6 months of weigh ins, discussions about nutrition and exercise and BMI from my PCP

5 years of medicals from my gyno showing a 5 year history of obesity.

Letter of medical necessity from my pcp.

Letter of recommendation for surgery from the surgeon.

Proof of attending a nutrition class.

Clearance by a mental health provider.

As far as out of pocket. My surgery was covered 100% through Cigna. I had to pay my office and Rx copays, $98 for 2 nutrition classes and the mental health provider ($98 total for all three), and that was it. The actual surgery and hospital were covered completely.

Dear Meg:

I have CIGNA too. When I started I had a BMI of 38.5, under the 40 needed for approval. But I had high BP,high cholesterol, and acid reflux. Those issues (comorbitities) helped to get me approved. Be careful with your "weight loss" program. You don't want to lose to much weight. Tell your doctor that you're exercising and following the rules. Try to lose a few pounds one month and gain a couple of it back in the second month and keep doing that. If you show too much progress, the insurance company will say that you've proven you don't need the surgery because you can do it without. Which is BS. Usually if you are at the stage where you are, you've already done all that and it just didn't work. This surgery is the best thing I have ever done in my life. Good luck.

Brian

So I sent in all my paperwork about 1 week ago. My surgery office's nurse said everything looked very 'nice'. There is one thing I am very worried about: The nurse gave me 6 sheets for my primary doctor to fill out, one for each month. This included my blood pressure, weight and diet plan for each month. I asked the nurse about my letter of medical necessary my primary doctor was suppose to write, and she said that my doctor didn't need to write one. I said I would get one just in case, but the nurse said Cigna will not even look at it, and not to waste my doctors time. I did what the nurse said, but now I'm EXTREMELY nervous!!!! Anyone have a similar situation and get approved?

Edited February 28, 201016 yr by megkpik

I submitted:

6 months of weigh ins, discussions about nutrition and exercise and BMI from my PCP

5 years of medicals from my gyno showing a 5 year history of obesity.

Letter of medical necessity from my pcp.

Letter of recommendation for surgery from the surgeon.

Proof of attending a nutrition class.

Clearance by a mental health provider.

As far as out of pocket. My surgery was covered 100% through Cigna. I had to pay my office and Rx copays, $98 for 2 nutrition classes and the mental health provider ($98 total for all three), and that was it. The actual surgery and hospital were covered completely.

Dana36

Were your 6 months of weigh ins consecutive?

Thanks,

Cathy

I have CIGNA as well, and I've got the plan where they'll pay 90%. I've had quite a few medical expenses this year (had to have a biopsy that came back non-cancerous, thank god), so I've already got my deductible and maximum medical out-of-pocket met.

I'm just beginning my 6-month program though.

A coworker of mine had hers done a year ago, and initially it was denied because she had only completed 4 of the 6 months. In total, it took her about 10 months to go through the 6-month diet and approval from insurance. :frown:

I have CIGNA as well, and I've got the plan where they'll pay 90%. I've had quite a few medical expenses this year (had to have a biopsy that came back non-cancerous, thank god), so I've already got my deductible and maximum medical out-of-pocket met.

I'm just beginning my 6-month program though.

A coworker of mine had hers done a year ago, and initially it was denied because she had only completed 4 of the 6 months. In total, it took her about 10 months to go through the 6-month diet and approval from insurance. :frown:

Was it because Cigna required her to have 6 consecutive months that it took her 10 months?

Cathy

Was it because Cigna required her to have 6 consecutive months that it took her 10 months?

Cathy

It didn't need to be consecutive, but she had only 4 months total.