Hello All,

This is my first post. I just joined ObesityHelp and I am thrilled to be here!

I am trying to get approval from CIGNA for a VSG. I am 22. My BMI is 57 and I've met all of the requirements by CIGNA. I did 3 months of weighing in starting on December 14, 2012. My second weigh in was January 21, 2013 and my third was February 22, 2013. I lost 9 lbs overall. I gained a little over Christmas and in January, but lost that weight +9 additional pounds. Anyway, I also was being monitored by a dietitian, and a psychologist. I had a psych eval and passed with flying colors. I had also initially talked to my PCP on October 25, 2012 about wanting to get the Sleeve and about what my options were and she was very supportive. So on February 22, 2012, my paperwork was faxed to CIGNA.

I have been calling them every single day (sometimes 2X a day) to follow up on the status of my claim. Well yesterday, March 1, 2013, I found out that my claim was being passed on to a medical examiner for revision. So that means the CIGNA nurse denied it initially. The basis for her denial was this:

-I did not meet the 3 month weight loss monitored program 

-I did not have a psych evaluation

-I did not have a letter from another doctor giving me approval for the surgery such as my PCP

So, I know the first 2 reasons are not valid and can easily be sorted out. The third reason is completely my fault. I thought the weight loss center would contact my PCP to get the letter for the packet before they submitted the request to the insurance...they did NOT do that. I'm freaking out here. I was told the medical examiner would review my claim on Monday or Tuesday of this next week. I know that if I do not have the letter from my PCP that my claim will be denied. If I can manage to get the letter to CIGNA via fax from my PCP then there's hope, but I'm scared that it won't make it to CIGNA before my claim is denied.

I was wanting to get this surgery on my spring break because I'm a teacher and that would give me plenty of time to recover before school starts back up.

Is there anyone out there can give me some advice? I really need it.

Best,

Lindsay

 

That's actually part of my plan. Comply and show them its not all its cracked up to be, and go to all fill appointments and nutrition appointments all while appealing. I followed the eating and exercise for a long time with not very good results. The dr never gives me a fill and I don't feel like I have any restriction. I hate this. I have felt like a failure for so long because I can't get this weight off, even with the band, and I am convinced my hormone imbalances due to pros and diabetes makes it extremely difficult to lose the weight. I need malabsorption to help.

Blue cross blue shield of nc

Wish I had more options like you. Roslin just went out of network for me too. Best of luck.