Hi guys

I am trying this again.  I originally tried for the Gastric bypass back in 2008/2009 but was denied due to lack of 6 month diet.  My doctor upto yesterday did not want anything to do with this.

Yesterday I went to my new doctor and she recommended  the Gastric before I could even ask.  She said that she was going to refer me to the hospitlal/program where they perform these procedures to get started getting ready. She asked if I had tried this before and I told her I was denied based on diet.   She seems to think they can get this done and soon.  

My question is it has been a couple of years since I have tried for approval and Horizon was pretty tough at that time.  Has the rules changed since then.  I had a case manager for Horizon tell me a earlier in the year tell me that she thought she could help me get approved but I needed to get well with my legs first.  I tried to call her back about a month later and she is no longer with Horizon. 

Just wondering if anything has changed.

 

Thanks for your help

Bob

 

 

 

That is 92 days from start to finish so you should be good!!  Keep me posted on what you hear about your approval!!

My first visit with the physician was i believe august 3rd  i dont have all the other dates available right now, but my pre op was nov 3rd .

Thanks for the reply,  well i know for sure i did not see the NUT 4 times on my 3 month MD diet. they scheduled everything for me and so i figured when i was done with their appointments i would be ok.  well i guess the NUT missed one appointment so i saw her august 27, sept 28, october 28th and  Nov 3rd.  at this point im sure im going to get denied, but i wanted to give it a try and see if tere would be any possibility for me to keep my surgery date of Nov 21st being that my mom already has the week off.

I've now been at my employer for a year which means in January my medical benefits will start. I am enrolling in a Cigna plan which my employers policy states that weight loss surgery is excluded unless deemed medically necessary with a BMI of over 40 (which I have), 6 months of an approved nonsurgical weight loss program, two years of medically documented obesity (my doctor has my pregnancy records from 2 years ago for my 20 month old son where my weight was obviously obese) and some other kind of unspecifed criteria determined by the plan administrator (no clue what that means).

What is a 6 month approved non surgical weight loss program that Cigna will approve?  If you lose any weight during that time do they deny you?  Reading on here it sounds like they do everything they can to deny you.  I am just scared right now. I've done everything I can to lose weight and I'm at the beginning of researching surgery and it is overwhelming

I've read some pretty negative things about Cigna here but the only other plan my employer offers is a Aetna plan that flat out excludes surgery with no medical exceptions