Question:
My Dr. wants to weigh me only every six weeks, Cigna wants every month
My P.C.P. says she wants to weigh me every six weeks for six months, not every month for six months, like Cigna PPO wants from me (from what I have researched here.) I told her this and she seems to think that every six weeks will be fine. Do you think this is just for her benefit before referring me to my surgeon, which she said she'll do in December, then he will put me on the six month diet for insurance purposes? I'm confused. P.S., if all I need is her evalutaion and after she does this, will that count as the "Medically Supervised" diet insurance companies want? — KristenRBonds (posted on May 30, 2007)
May 30, 2007
If your PCP isn't willing to conform to what your insurance wants, time to
find a new PCP. It doesn't sound like she would support you after the
surgery either. Something to seriously consider, as you WILL NEED a PCP
that supports your decision. Also, have you ever had a medically
supervised diet? You can appeal Cigna wanting you to get a medically
supervised diet, as they don't work. For my appeal for Wellcare, I found
that both the FDA (food and drug administration) and the NIH (national
institute of health) both clearly state that medically supervised diets
don't work and that a large amount only lose about 10% of their weight and
then gain it all back, or quit partially through the process because it
isn't working. I'd do a great deal more research into this and push harder
to get this surgery. I think it's horrible that all these insurances are
forcing the obese/morbidly obese to "suffer" through a medically
supervised diet when they rarely work! It's just a stall tactic that needs
to come to a screeching halt. If you have any questions, don't hesitate to
contact me. Good luck!
— crystalsno
May 30, 2007
Kristen,
We have the same insurance. What is her rational for averting the insurance
instructions. If you have chosen a weight loss surgeon, check with them to
see if they will conduct the 6 month weight loss. Even though I missed a
few visits because she was out of the office, I got approved. I didn't
have any problems getting approved. If you like your PCP, speak with
someone at Cigna to see if this physician policy would be okay. However,
doctor's know how to write this stuff up. Since you have a PPO, you don't
need a physician referral. I picked my own weight loss surgeon and he is
great. Cigna has certified bariatric clinics --log on to the Cigna site
and see which clinics they have certified in your state.
— the7thdean
May 30, 2007
HI,
I am 8 days op and my diet had to be once a month for 6 months and had to
state what foods to eat, BMI & exercise plan for the insurance to
accept it.
— Alvernlaw
May 30, 2007
I, too, have cigna ppo. I did the six month diet through my surgeon, and
then was denied, the insurance stating that the diet had to be monitored by
someone who does not do the surgery. I had to start all over, with my PCP
monitoring me, for six more months! It took me a total of a year and a
half to get to the point of surgery, but it was well worth it! I have lost
107 Pounds, and met my goal in nine months! Good luck!
— earthangel
May 30, 2007
Most insurances will use any excuse to deny the surgery. If you don't get
the every month chech-in w/a Dr they will deny.
— Donna O.
May 31, 2007
Kristen, I really encoruage you to call your insurance company and ask them
these direct questions. What do they want? If they want weight every
month and then a report from your doctor, then that is why they need to do.
If your PCM can't do this, find another doctor, because your PCM is
working against you not for you. If she doesn't follow their guidelines,
it can cost you another 6 months wait for surgery for nothing. Follow the
rules with your insurance company, they hold all the cards for approval.
Take care, Patricia P.
— Patricia P
June 3, 2007
Cigna will deny you! Find a new PCP. They have stated to me that you have
to be seen every 30 days. Miss one and you have to start over.
— Creis
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