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Hi All,
I have Aetna insurance and am planning on attempting to get approval for VSG. My only issue is that I do not have the 2 year MEDICAL record of my BMI. After I had my son in 2009, I did not have a medical record of my weight until February of this year. I was a slacker and didn't see my PCP and I didn't get sick at all and need to see a Dr. Since February of this year, I have seen the Dr a LOT, as well as a cardiologist, etc. I was just wondering if anyone has had experience with getting around this requirement or if there is anything I can provide in lieu of a medical record. For example, in 2012, I started a weight loss blog online and I actually posted photos of the scale while I was standing on it which clearly shows my weight during the year 2012. And of course I could provide photographs, although that too seems like it may be a stretch. I plan on asking my PCP for a letter of medical necessity to explain that I have been morbidly obese for the entire time I have been her patient (over 10 yrs), but I don't know if that is enough.
I don't have any records from urgent care, WW, a gym or anything like that. My personal blog and photos are really all I have to document my weight during the year 2012 (which is the year I need to meet the 2 yr requirement). I know I can just put off having the surgery for another year but I probably won't be with the same employer in a year and my husbands insurance doesn't cover WLS so I feel like this is my only chance.
What do you guys think? Is it worth submitting this information and seeing what they say? Has anyone ever heard of a success story using other means of documentation? Am I just out of luck? Any advice??
Thanks!
Sleeved 6/12/13 - 100 pounds lost to get to goal!
Sleeved 6/12/13 - 100 pounds lost to get to goal!
Does anyone know if KY Medicaid thru Anthem BCBS requires a 6 month supervised diet? Any info. would be appreciated! Thanks!
Hi there kitkat88,
The Lap Band or the Sleeve was not for me. Had the LB in 2008 I hated it, lost 14 lbs and gained 17 lbs. I was revised to the Sleeve in 2009 I lost some weight about 30 lbs and gained back most of the weight. If you have a problem with eating white carbs like I do the the Sleeve will stretch and you will gain weight. I also have a Hiatal Hernia with the Sleeve. There was a study made this year and it showed more Sleevers gained their weight back and developed a sweet tooth, even if you never had one before. That is exactly what happened to me, now I love cake, cookies, candy etc..... I did not want to get the DS because, first of all BCBS Federal will not cover it if your BMI is lower than 50. So, that is my story. I am going for the Gastric Bypass RNY.
Thanks for replying.
Virgie Tschirhart
Lap Band - 2008, Sleeve - 2009, RYN - 2017
Started Program Weight July 13, 2017 - 194.2
Before Surgery Weight December 27, 2017 - 185.0
Current Weight - February 2018 - 161.0
I did not lose any weight and was approved the first time. Be careful not to drop below their minimum BMI requirement w/o comorbidities.
Hi guys - looks like you went through the surgery successfully using Cigna's coverage. I am just starting the process and curious about their 3 month weight management requirement. I am right around the 40BMI mark with no comorbid conditions. On this 3 month program are you required to lose weight or can you stay stable and still be approved? I'm sure I could get down 20lbs or so, but it would be the same 20 I've been losing and gaining for the last decade. I'm looking to make a permanent and major change. I'm worried 5lbs will be the difference between being approved and not. What were your experiences with Cigna's policy?
I dont know I hear from 24 hours to 30 days lol but im still waiting for my papers to be sent to the insurance company!!!
May I ask why the revision? Good Luck
Hockeymom87 · 0 replies · 858 views
