Hi there-

I was denied for no evidence of mechnical failure of the original procedure. All my EGD and barium swallow tests keep coming back normal but Ive been in agony off and on for the past 2 years with a 10 year old band. It feels like the band and port are both pulling. Ive had to go on strong pain meds for it and yet there is no evidence of mechanical band failure. They also denied saying that weight loss surgery to treat diabetes with a BMI under 35 is considered experimental. Problem is the insurance person put the wrong weight and Im not even DIABETIC!! I have a BMI of exactly 35 right now. I got a letter from the surgeon saying that a mistake had been made and that my correct weight is 230 and BMI is 35. He also corrected the diabetes diagnosis. I have a bunch of other co-morbidities and take 7 meds a day. Ironically, diabetes is the only thing I dont have. The whole thing has been a nightmare. I thought it would be easy with all the problems that I already have. Congrats on getting your surgery done!

I received a notification from Cigna today that my request for an independent review of their denial was being sent to a company called MCMC which I think stands for medical care management corporation. Has anyone else had any contact or experience with these guys before?

My first appt was July 12 then August 12th, Sept 13th and October 11th!  I thought that Sept 13th was going to be the last but it was 3 months from the first visit.

Your two appt. you had in Oct wasn't a good idea!  Remember 30 days from the last appt.  Good luck!

I appreciate you chiming in.  My first consultation appt. with the dietician was Oct 16 she said we could meet again the next appt on Oct 30.  Next visit was Nov 22.  My next appointment is Dec 11.  I suppose I will have to do another visit to make it 4.  But the days between the visits are too early.   I was trying to get my visits done as soon as possible so I could get the surgery done before January.  

Looks like i scheduled all these appts wrong.  I bet that I will have to start all over again.    I am going to call BCBS tomorrow to confirm that.  

So did you have to do your appoints all over again since it was not 90 days?  

My doctor's office called me last week and said that BCBS Federal called her and said, I did not have the required Nut 3 month visit reports.  She told me that I had make 2 more appointments with the Nut so I did.  I saw her on the 22 November and my next appointment with her is on 11 Dec.  I also received a letter from BCBS Federal yesterday saying that my predetermination was denied, because of not providing 3 month Nut appointment reports.  In addition, it was also noted that I was not in compliance with my 2 previous weight loss surgeries as far as dieting and exercising.  BCBS Federal on approved the LB back in 2008.  I did self pay on the Sleeve in 2009.    I called the doctor's office and she said when BCBS Federal called her they said they would be sending out a letter saying it was denied but she said they would accept the next 2 reports from the Nut when I complete them on 11 Dec 13.  She said don't throw in the towel yet! 

Has anyone else had a similar case like mine?   Thanks.

Update: I decided to go with Dr. Lana Nelson in Norman, OK.  If I could have started all over again, I would have gone with the RNY, instead of the LB back in 2008 and then revised to the Sleeve 2009.  Dr. Lana wants to repair my hiatal hernia once and for all and at the same time revise the sleeve to the RNY.  I am doing so well right now on the 3 month program that BCBS Federal requires.   These are my appointment dates, I hope they are according to their requirements:

1st Visit on 08-25-14

2nd Visit on 09-29-14

3rd Visit on 10-27-14

4th Visit on 11-24-14