Question:
Has Cigna gotten tougher to give approval?

I have Cigna POS in Virginia. I have heard from quite a few people that they have gotten a lot stricter in the last year as far as approval. I have a bmi of 43.7 and several comorbities. Has anyone had problems with them in the past 6-8 months in getting approved. I just keep hearing bad things about Cigna and it is making me kinda scared that they will give me a hard time. thank you for any info you can give me.    — taterbug898 (posted on March 16, 2004)

March 16, 2004
First off make sure that wls is covered. My husbands employer changed the policy with Cigna this year and it no longer covers wls. They are very strict about the dietary requirement, they will not budge one week on it. Cigna also seems to lose paperwork on a regular basis and noone every knows anything. Be sure to get a name everytime you call them and if possible try to get one person who will deal with you. Good luck.
   — bubbleboo K.

March 16, 2004
In some states Cigna has stopped paying for WLS for any reason. If they do pay, they are VERY STRICT with their guidelines. If no one at Cigna will tell you what the requirments are (they told me I didnt have access to that info) then ask your PCP to get the low down for you. Cigna will talk to doctors offices. The last I heard they required 2 26 week supervised diets. They dont budge on that so if you dont have it, start Weight Watchers or another program TODAY. They do accept WW, Jenny Craig, ect... and even weekely weigh ins at your PCP's office. One thing is true about Cigna, they LOVE to stamp DENIED on your first attempt even if you have all the requirments. If you give up and go away, they save ALOT of money so DONT GIVE UP!!! Hang in there and GOOD LUCK! ~Sidney~ Open RNY 10-23-02 down 140+ and below goal
   — Siddy I.

March 16, 2004
I'm afraid I have nothing positive to say about Cigna's approval process either. While I have been approved it took a year from the time I first submitted my paperwork. Here's what you need: Proof of duration of BMI greater than 40. Two "failed" supervised diets of at least 26 weeks each with monthly weigh-ins. Medical documentation, not only a written letter from your PCP, but actual treatment notes, test results and medication lists as well as notes from you Osteopath (if you have arthritis) your Gastroenternologist (if you have GERD), your Pulmonologist (if you have sleep apnea) etc. I was requesting the DS but they responded saying "that procedure was not on the approved list of bariatric surgical procedures". After meeting all of these requirements they scheduled a phone conference with their appeals committee . Moments before I was to speak with the committee they called to tell me I was approved for the roux-en y procedure. This was four months ago. Also some are saying they now require a Psych eval. and even if they don't, your surgeon might. In the meantime paperwork does get lost, no one knows anything about your case and you're not allowed to speak with anyone who does. So not to be overly negative because in the end it is possible to get approval. I just want you to know what you may be in for. There is a webgroup called cignassqueakywheels that is very helpful. Best of luck!
   — Teri F.

March 17, 2004
Last year I was denied by Cigna because they said I needed two 26 weeks of supervised diets. I had one, and the person that my doctor spoke to said all I had to do was go to Weight Watchers for 6 months and I'd have everything I need. I started Weight Watchers but decided to go to a doctor instead. THANK GOD I DID! When we submitted another request two months ago they told me that Weight Watchers does not qualify because there is no doctor participation! Can you imagine that -- after they're the ones that suggested it? Anyhow, they denied me again, saying that I hadn't met the requirements. My doctor's office called and pointed out that the documentation was right there, under their eyes. They lost the paperwork and we had to resubmit two times. Finally I called and told them that I was going to contact an attorney because of their incompetence. I received an approval letter the following week. Do not let these people bully you. Keep praying for God's intervention and keep pushing the insurance company. Hang in there.
   — acanesfan296

March 17, 2004
I have Cigna and Medicare..I live in Massachusetts and I WAS a diabetic...I say was because I now (due to rny on 1/27/04) have normal blood sugers...I NEVER had one problem getting approved but that may be because of the diabetes...Good Luck to you!
   — Redbunny2

March 17, 2004
In a word - yes. My husband was denied with Cigna POS last year (July 2003). His BMI was close to 60 and has sleep apnea and high BP. Because he did not have 2-26 week doctor supervised diet trys they would not pay for his surgery even though they (Cigna) deemed it was medically necessary for him to have the surgery. Now he had doctor supervised diet trys with a doctor that was not his PCP but they would not recognize those trys. Good luck.
   — ChristineB

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