Question:
Do I really need 6 months Dr. supervised diet?
My insurance (Cigna) says that I need to provide documenation that I have tried to lose weight under the care of a physician (seeing them once a month) for 6 consecutive months in the past year. I am so panicked that I will have to wait another 6 months. This process is so mysterious and confusing. I can't even find a good pcp to go to. — Charmaine S. (posted on January 12, 2005)
January 11, 2005
Sorry for the blunt answer, but no you do not need it if you have the money
to self pay. If you don't, then it's best to start right now and get on
with it. From what I have seen over the last 2+ years of being on this
board, is that Cigna stands very solid on this requirement. Look at it as
a time to prepare yourself both mentally and physically for surgery. Start
to increase exercise and make some better food choices - you will have to
after surgery anyway. I know it's not easy and you may just be dieted out
but this is a costly and potentially life ending surgery and they want to
make sure people going into it are willing to do what is needed. It also
will help shrink your liver making the surgery easier to do. 6 months
isn't bad compared to some of the insurances. If you have 6 months of
doctor supervised diet within the last 2 years then I would push the issue
hard, but if not then bite the bullet. In the meantime maybe you can get
all your pre-op stuff done so that once you have approval you can go
quickly.
— zoedogcbr
January 12, 2005
I had cigna. my surgery date was 11/29/04. you do have to have the 6 month
supervised diet. believe me. cigna is very strict and if you dont have all
requirements they ask for they will deny you. I heard all kinds of things
about cigna and they were all true. I had 67 pages of medical documents.
6 month pcp supervised diet, saw a nutrionist, psychiatrist, and kept a
food journal for the supervised diet , letter from my pcp and surgeron.
they denied me. I had to get a lady to help me with an appeal letter,
which was excellent. sent it in with the exact same documents and got
approved in 2 weeks. go figure. they dont want to pay for it and want you
to give up. but if you really need this surgery like I did and many others
do you wont give up . just do everything they require. just have all your
ducks in a row and you will be fine. it was worth it to me. I am now down
30lbs in 6 weeks and off all my meds but 1. so it was worth the fight.
you will get there just dont give up. you may get approved with no
problems. good luck. email me if you have any questions.
m.mills
— taterbug898
January 12, 2005
I also had Cigna insurance pay for my surgery. You can check out my
profile for the long drawn out episode. You are going to have to get that
diet done. I know six months seems like a long time. You can be prepping
for surgery six months from now or be wishing you were prepping. Kimberly
- Roux-en-Y 9/25/2003. Started 253lbs, now a happy 135lbs.
— Kimberly S.
January 12, 2005
Insurance companies are making it harder and harder to get approved. Go
ahead and start the diet (trust me 6 months will go by fast). I fought
with BC/BS of IL for over a year about the diet. When you start, make sure
you explain to your physician the more documentation the better. (When I
submitted my 6 month diet to my insurance they said I didn't have enough
documentation from my doctor!)
— Kara J.
January 12, 2005
Unfortunately, it is perfectly legal for them to require all that
documentation to justify paying $30,000+ for us to have surgery. Don't
give up and don't lose hope. It took me over 4 years to have my surgery
even with legislation in the state of Virginia on my side. You'll get
there. Don't get panicked because every day you go through all the red
tape, you're one day closer to being on the other side.
— SnowWhiteDove459
January 12, 2005
We get many folks approved without the full 6 months of medically
supervised weight loss on CIGNA (and many other insurer) cases. However,
it is advisable that you start such a program ASAP (it won't cost too much,
if anything at all) through your PCP, as it puts you in the best possible
position to obtain that approval. Good luck! Walter Lindstrom
www.obesitylaw.com
— Walter Lindstrom
January 13, 2005
Don't give up. Aetna required the same thing. My doctor was confused but
referred me to a nutritionist. I didn't have to "lose" any
weight. I didn't lose 1 pound. Gladly I did't gain any. I was approved 1
week after completing my required 6 months.
— Tee H.
January 13, 2005
That is what my insurance said they REQUIRED. I panicked when I got my
pcp's records and there was very little documented over the past 8 years.
And I had done several attempts at physician supervised diets. Even
medications, but I could not tolerate them due to high blood pressure. I
gave the medical records to the surgoen and I was SHOCKED when my insurance
approved immediately. I could not believe it. I would try to find a surgeon
that had a success rate at approvals to get approval for you. I would go
ahead and start seeing a nutritionist and have them document your visits
fully. Good luck and maybe you, too, can get a quick approval.
— debi327
January 14, 2005
I too have Cigna PPO in California. I'm in the 1st month of their stupid 6
month requirement. Although, I've dieted for over 10 years I had no
records from a doctor showing I did. I decided that I would play the game
that Cigna wants to play. It's just another one of their stalling tactics
but if you keep up your end of the bargain, you will eventually win. If I
were you, I would start the 6 monther. I was able to find a very good PCP
(referred by my surgeon) and he's behind me all the way. He deals with
Cigna all the time and knows exactly what to put in my chart. All I have
to do is show up once a month. So like the previous poster said, would you
rather be scheduling your surgery in 6 months or starting your diet in 6
months? It's up to you.
— J. Bee
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