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Topic: RE: VSG or RNY?
The surgeon's suggestion is a suggestion, but ultimately it is your decision which surgery to have. If you want the gastric bypass, and you meet the criteria to qualify, I don't see why you can't get it. If your surgeon won't do it, I might talk to a different surgeon.
Good luck!
Tonia
Good luck!
Tonia
RNY 11/15/2010
HW 280ish
SW (after 6 month diet) 247
Lowest post-surgery 183
Current 241
Considering revision to DS - have appointment 8/15/2017
Topic: RE: Better after a good cry
I would talk with the surgeon directly about what you want to do, and get him/her to put pressure on the insurance person to submit the paperwork anyway. I would bet the surgeon would rather try and have the possibility of getting paid for the surgery than to lose you to another surgeon.
Good luck!
Tonia
Good luck!
Tonia
RNY 11/15/2010
HW 280ish
SW (after 6 month diet) 247
Lowest post-surgery 183
Current 241
Considering revision to DS - have appointment 8/15/2017
Topic: RE: Denied by Cigna
I thought you were talking about me for a minute... I am in the same situation... pre-cert denied, appeal denied all because the physician supervised program wasn't to their liking... my doc and surgeoun think its absurd but what can you do... I restarted a physican supervised program in August and hope to start over mid January.
Topic: RE: Are nut & psych evals covered by Cigna?
I have Cigna PPO in Missouri. My visits to the dietician and psychologist last week were covered, I just had to pay the specialist co-pay amount of $35 per visit. I am a self-pay for the actual surgery, since I didn't want to mess with six months of supervised diet and exercise (and I want the surgery NOW, not in the middle of summer with lots of stuff going on).
Lori 5'2", HW 240, SW 207, lost 18 lb on the preop liquid diet, CW 168
Topic: Denied by Cigna
I am a little ticked I have been denied wls thru insurance provider cigna. My BMI is greater than 40 and have 1 co-morbidity. Well I knew they required 6 months of weight management supervised by a doc so I started a program at the surgeons office. However, I also did a weight management program back in 2007-2008 thru another doctor in which I lost 70 lbs. I had all of these records forwarded to my current surgeons office. I attended this program for about 8 months every week. I kept a food log for the most part and doctor took notes and everything. All of this information was submitted to Cigna along with all the other paper work they required including note from my primary care doc, psych eval, current nutrition visits etc. Well I got denied. The surgeon’s office did a peer to peer review but again they same doc or nurse reviewing my case still denied my request saying the weight management program I did was not in the last 2 yrs. Which is one of their criteria. Ok so I receive the denial letter and I saw the terms for the denial see below They mentioned the failure of a weight management program in the last 2 yrs as however, they went on to say of the person has long standing morbid obesity evidence of a weight management program in the last 5 yrs is sufficient.
You mean to tell me they couldn't let a few months go for the 2 yrs? Why wasn't my weight management program information sufficient for the 5 yrs? I know it said long standing obesity but when i called Cigna for a definition of what they deem long standing I couldn't get an answer.
I am feeling a bit discouraged at this point has anyone run into this problem? Is this the true stall tactic by Cigna.My next step is to appeal in January by then I will have completed the program at the surgeon’s office in which I was doing in parallel along with current submission. I have also asked to receive some medical records from old doctors dating at least 10 yrs back. I am going to see what happens next.
Topic: RE: 6 month diet/gained weight!?
This happened to me also. I was not required to lose necessarily by my insurance (Aetna) or my surgeon's office, but during the physician supervised diet, from start to finish, I was 6 lbs heavier!!
Nan
HW 300 / SW 280 / CW 138 / GW 140
Hit Goal 4/2/2010
Topic: VSG or RNY?
Hi guys :) So, I saw my surgeon yesterday and I basically had my mind set on Gastric Bypass. She asked me if I was a sweet eater(which I'm really not) and a few other questions and finally recommended the sleeve. One problem; Blue Cross does not cover it yet for people with a BMI between 40-50. So, now I am stuck. She said the RNY would work also, but the sleeve is not as risky. Now I am torn, because she said I could wait, she feels that my insurance will eventually cover it. What should I do? I know I have been overweight for a long time, but I am tired of waiting, and who is to say how long it would take for Blue Cross to agree to cover it? Have any of you fought it and won? If so, what did you do?
Topic: RE: Can someone please tell me if this means the sleeve is covered??
To me too it looks like it is now covered. Good luck to you.
Kim
5'0"
"In two decades I've lost a total of 789 pounds. I should be hanging from a charm bracelet." Erma Bombeck
5'0"
"In two decades I've lost a total of 789 pounds. I should be hanging from a charm bracelet." Erma Bombeck
Topic: RE: 6 month diet/gained weight!?
Oh yes. I had this issue. I had to follow a 3-month program. I was not required to lose weight, but I knew gaining weight would be a problem. About 6 days before my final weigh in, I saw that I had gained 4 lbs.
I immediately went on a strict "diet" along with taking Alli pills I still had in the cupboard. When I weighed in, I was only up 1 lb. The doctor wasn't concerned about that at all. He told me as long as I didn't gain significantly (5 or more lbs.), everything was ok.
I immediately went on a strict "diet" along with taking Alli pills I still had in the cupboard. When I weighed in, I was only up 1 lb. The doctor wasn't concerned about that at all. He told me as long as I didn't gain significantly (5 or more lbs.), everything was ok.
Kim
5'0"
"In two decades I've lost a total of 789 pounds. I should be hanging from a charm bracelet." Erma Bombeck
5'0"
"In two decades I've lost a total of 789 pounds. I should be hanging from a charm bracelet." Erma Bombeck
Topic: 6 month diet/gained weight!?
I am freaking out! Ok so this Friday is my "last" visit with PCP for the 6 months of supervised dieting and I stepped on the scale to see that I have gained 3lbs! I have been doing everything as I should be and this is the first time that I am gaining instead of losing! I am hoping this is jus****er weight and will be gone by then but did this happen to anyone else?
Help!!!!!!!!!!!!!
Help!!!!!!!!!!!!!
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