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I have BC/BS. I completed 3 months of the required 6 month diet/exercise program that was supervised by my PCP and NUT TWO YEARS ago for ins. purposes. My insurance rep. that works with the surgeon's office said that she wants to send in everything I have now, (including all med. records and previous attempts for weight loss from 2 yrs ago), to just see if my ins. will approve my surgery.
Does anyone think this is a bad idea? I have since developed sleep apnea, my BMI is around 44 and I have pre-diabetes. I don't want to blow my chances for approval. Does anyone think this will? Just trying to get people's thoughts on it. I am wondering if I should just do the six months all over to not blow my chances, but I don't know if her sending in everything will do that either. Any thoughts anyone?
Hmmm, that is so weird. Do you have BC/BS? I can view my policy online. Can you do that? I wonder if you contacted your HR Dept. at work if they can send you the full written portion of your policy, (just the weight loss portion)? Let me know if you find something out, can you? I am very confused on who to believe. Since my posting I have contacted the insurance rep. that works for the surgeon so she can check. Sometimes they know how to word things to your insurance company. That may be a good idea too.
I'm in the same boat. My insurance said (the rep I spoke to) did not see a mention of six months. It angers me because I'm a revision and if I don't need to wait I won't. I too asked them for written section regarding bariactrics and they sent me some handbook with no info! Frustrating.
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The conference for this year will be held in Los Angeles, California on August 15-16, 2014.
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I am just getting started in my journey to hopefully have WLS this year. I contacted my insurance and asked them for a copy of the bariatric portion of my policy, specifically the weight loss surgery section of it. They sent me a copy and it did say that I needed to complete 6 consecutive months of supervised weight loss program that needs to be done through my PCP and a Nutritionist. I called them once also and asked them what I needed to do for approval and they said basically the same thing. My surgeon's office called today and told me that they spoke to my insurance company and they were told that I didn't need to do the 6 months before applying for surgery. Does anyone have any suggestions on what I should do? I am so confused now.
I have Cigna and they require 3 months of PCP supervised diet and next week I am going for my first month weight in (one month down and two more to go), but I am thinking I am 2 pounds more than when I started. I think it is because I am getting on my period and because I have been very constipated in the past couple of weeks, but who knows and the insurance doesn't care anyway. But my question is about what kind of diet did your PCP put you on? Was there a diet? What did he/she tell you about changing of habits? I was expecting she would talk about nutrition or give me some sort of guidance but all she said was to eat 3 times a day, exercise at least 30 mins 3 times a week, and to carry small snacks with me since I am always on the go and I don't end up eating out or late.
What was your experience with your PCP in your first appointment? Because I felt like a deer in a headlight- no guidance, no direction, no nothing.
I am going through the same crap. I had my band placed in 2003 and only lost about 20 lbs.. I had fills and unfills and never could get it right. it was either everything went down with no obstruction or completely nothing for the first 3 years with the band. Then, Went through lots of IVF treatments and had 2 kids then nursed both so for 6 years I couldnt have a fill in my band anyway. Went to the original surgeon who placed the band. (HIS OFFICE LOST MY ENTIRE ORIGINAL FILE!) Last 2 years started trying again to see if I could get the right fills level. This time the band started causing loads of pain. Turns out trying to get it filled the last 2 years caused a severe slip and it i****ting my diaphragm. So, fought Cigna for the past year and they finally agreed to pay for band removal but will not pay for revision to sleeve due to non-compliance. So Cigna is saying that I meet all the other criteria but until I produce that now non-existant record, they will not pay for sleeve. How are we supposed to argue with that? To say we were not compliant is an opinion, not a fact. I would saying trying for years and years to avoid surgery again and work with a sleeve that isnt helping, is compliance. 
Thank you! I did exactly what you suggested over a week ago. I waited a couple of days and then called and left a voicemail with the insurance company asking if they had received anything. No response. I left another message on Monday. No response. I emailed the insurance company to ask how to escalate customer service issues and was told a supervisor would contact me. No contact. Grrrrrr....
HW: 387 (12/13) ConsultW: 383 (12/13) SW: 321 (4/9/14) CW: 234.6 (10/19/14)
No, you are not being unreasonable. Sorry you are having such a hard time. Maybe get the exact number from the insurance company of where to send the paperwork to then give that to the bariatric office and ask them to resubmit. Good luck!
Hockeymom87 · 0 replies · 727 views
