Question:
Am I on the right track?

I have Cigna/HMO, with Huntington/Seaview as the provider network. I have an appointment with my PCP week after next, for a general physical and also to ask him for a referral to the WLS surgeon (Dr Anthone, who is a Cigna provider) I have already verified with Cigna that gastric bypass surgery is covered if medically necessary. I plan on bringing my weight loss history, inc. Dr records from 1 medically supervised plan. (The other Dr supervised plan was from 11 years ago, and is out of business - can't find any records.)In addition, I plan to bring printed information for my PCP to read, to help convince him that a referral is the best thing for me, that i have caredully considered this, etc. Is there anything that I am missing to help get an approval for this referral? Thanks for any suggestions! Ellen    — Ellen B. (posted on June 12, 2000)

June 12, 2000
Hello Ellen: I had LAP RNY in 9/99 and was covered by Cigna HMO. My story is a good one. My PCP "suggested" surgery to me even though she had never done that before. I brought in the info like you have listed above and luckily I had been on 1 physician supervised fast about 5 years ago. I also just listed what other programs I used and the approximate dates. I did not provide documentation in writing of any of these. It really was up to my PCP and Palo Alto Med. Foundation to approve it. Once they did, I was home free. I only paid $100 to the hospital the morning of surgery and some co-pays. I also paid out of pocket for a test that would have taken too long to get approval. I think it was around $200. I think you have the information you need. Just convince the PCP of the importance of this surgery. My BMI was about 41 and I had arthritis as a co-morbidity. I really hope it works out for you. Good luck.
   — Dot W.

June 12, 2000
Ellen... I'm a patient of Dr. Anthone's. I had surgery in October of last year. It sounds like you're all set. I would suggest to call Dr. Anthone's office for a consult appt. if you haven't already. I hear there is a long wait. Please let us know how it goes and when you get your appt. Take care for now.. <br><a href="http://www.mywls.com">http://www.myWLS.com</a>
   — [Deactivated Member]