Question:
Down with my insurance company!! Age an issue??

Hello all. I am 20 years of age, weighed 338 lbs. and am 5'4". When I met my surgeon, he told me to lose 10% of the weight, 30 lbs, or forget the surgery altogether. He wants to see how determined his patients are about this. He was blown away by how dedicated I was and I'm now down to 300 lbs. after about three months. I called my ins. co., Cigna (I'm on the HMO plan) and they said they wanted a letter from my PCP and surgeon, a psych eval and proof of a supervised six-month diet that I'd been on. I had tried Xenical for six months previously under the supervision of my PCP. We turned everything into them and thought it would go to the review board next. Wrong. They called back a week later and said they needed proof of another supervised six-month diet plan and for me to get an appointment to see a Nutritionist. I was very upset, because I'd really like to get this surgery before the summer's end as I start college classes again in fall. But I went ahead and sent them another diet (I'd been with Weight Watchers for six months in 2001) and also a very detailed letter of my entire dieting history. All I needed was to see the Nutritionist and I'd be all set! When I went to the appt, however, the Nutritionist apparently thought I was to be on a six-month diet with her before they'd consider me for surgery. I thought she was to help with the after surgery care. Neither of us are sure what the insurance wants. All I know is I've been on diet after diet since I was eight, and there is NO WAY I'm going on another six month diet that isn't going to work!! I will if I have to, but I am SO TIRED of jumping through these hoops! Do you think that the fact that I'm only 20 years old is putting my ins. co. off? It's like they think I'm 20, stupid and don't know what I want so they want to run me through the wringers a few times. Should I try to look into self-pay? Should I wait on the insurance co. and do what they ask? Please help.    — mars.renee (posted on July 23, 2003)

July 23, 2003
I don't think that it is due to your age. We all have to jump through some sort of hoops to get this approved. Some insurance companies are worse than others. I know of one ins here that makes you wait a mandatory 6 mos before even talking about a surgery date. This is after you have researched and pumped yourself up for this and have been on all the diets, etc. They still make you wait, like cattle going to slaughter... <P> I find this somewhat disturbing, as the obesity we have is going to kills us, and yet they make us wait and jump...now if we had stomach cancer or something to that nature it would be a non-issue you would have been under the knife in a few hours. <P> Best thing to do is document everything, get everything in writting, play their silly games, and fight when you have to (such as making you do another 6 mos diet). <P> Good luck to you
   — Pookie B.

July 23, 2003
Cigna is a bear to deal with. I started my process in January 2002. Luckily my surgeon's office told me the strict requirements. I went to my PCP that week and at the time Cigna only required 3 12-week diets, one of which was in the last year. We started the 12 weeks--finished in early April. I had to fight one denial in late March, but was approved in late May and had my surgery on August 15, 2002. Besides--another diet isn't going to hurt--this process is about changing how you eat for life anyway. It will get you ready for the process. I lost 41 lbs during the waiting and another 150 since the surgery. Hang in there. Just document everything they want and bury them with paperwork. And be persistent.
   — Cathy S.

July 23, 2003
Any insurance company can be a bear if you don't know what you are asking them to do. I was approved by CIGNA in just a few hours. I made sure I had all my ducks in a row before I sent in anything and I made sure I was familiar with the parameters of the contract. If you have insurance through your employer, go to human resources and see if there is someone in benefits that can go to bat for you. It took me seven years and four insurance providers before I found one that would approve my surgery. So keep your ultimate goal in mind, not the idea of how many hoops you must jump through. Things will fall into place but you must be willing to be patient and to provide the information and back-up to the questions they ask. Know what you need to provide to them before you go any farther. I don't believe it has anything to do with your age, it is just the regular string of events that everyone must deal with when making this type of request.
   — Anna B.

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