BMI too low? Cigna help

Hi guys, a little history: I am an old newbie/lurker. I joined OH years ago to get support for a experimental procedure called TOGA.  The procedure was unfortunately a failure and lost its funding because of it. My start weight was 265-highest ever, I got down to 245ish during the liquid/soft stage and over the years yo-yoed between 220 and now back up to 255-60 depending on whether I was on weigh****chers, juice diet, or whatever. I have side effects of a WLS (productive burps, reflux, can't vomit) with none of the benefits of actually having a tool to help me. I can eat ANYTHING. I get restriction for a few bites and then I guess the food passes through into my real stomach after a few minutes :/ Anyhow, I was going to go to MX for a revision but about a month before my date there was a huge scandal with my surgeon and I backed out. So now here I am.

My current dellima: My DH job has gotten new insurance that covers surgery (PTL). I was planning on getting an RNY and I have my consult in 3 weeks with the same Dr that did the trial (Erik Wilson). However after I started actually doing more research I realized I WANT DS! I really want to be successful, I am so depressed and sick and tired of this yo yo. Its affecting my self esteem, my marriage because I am ashamed, I hate going places now even at events with my kids its a struggle because I am so ashamed. I want to succeed and never be at this point ever again. I am terrified of the RNY failures after 5+ years. I was excited about DS but as I was reading my requirements, I got to the part of what Cigna would cover and DS is covered but only for BMI over 50. No exceptions for co morbidities or anything. I was crushed when I saw that. I am willing to put up a fight but on the other hand I don't want to risk not getting any surgery whatsoever or prolonging this too long. The doc office said I could get approved within 3 months. DH thinks I should just accept what they offer, "Be happy they even cover anything" he says. I know I haven't even had my consult yet but the patient advocate is very confident that approval will be no issue but that is for RNY. Is there a chance with CIGNA for the DS with a BMI of 43? How hard of a fight would I have to put up? I am hoping the fact that I have chronic inflammation from a previous knee and hip surgery will work in my favor because I just found out that I can't take NSAIDS with RNY and I usually take a prescription strength Ibuprophen when my joints get bad (like now). I also have plantar faciitis which I take the Ibuprophen for. I also struggle to keep my anemia under control as is, and I take slow release iron daily and Rx iron when it gets too low. Is there any advice that you guys can help me with? Should I settle for the RNY or fight if I am denied? How long is the process of appeal? Could they just say no to any surgery if I make them mad? Also my concern is that maybe next year they might change the plan to where there is no coverage. I am going to bring all of these issues up with the advocate but I am so stressed out that I need to vent/talk and get some advice to ease my mind.

Thanks y'all.

If I were you, I would not settle for another surgery just because that's all I could get. I would rather self-pay for the surgery that's right for me than settle for one I'm not sure about. (Think twice, cut once!)

I'm sorry I can't help you with the insurance question, but I do know there's a company that helps people with their WLS appeals: Lindstrom Obesity Advocacy. I can't recommend them from personal experience, but I've seen several posts on OH about them.

Good luck!

I agree that you should not settle. The NSAIDS issue shoud tilt it in your favor. And,no they can't just deny you any surgery you are qualified for if you make them mad. 

I second lindstrom advocacy. Often a usually free phone consult with them and they can't tell you exactly what they can do for you. 

Gl

Ladybug, no one should have any kind of bariatric operation unless they are confident about their decision and commited to it. That's how you feel about the DS. It's NOT how you feel about RNY.

It is possible to appeal these denials successfully, and it doesn't take a year for appeals, so you would still have your coverage if you should lose your appeals. And no, they can't deny you medically necessary care just because you appeal a denial or out of anger.

I will send you a pm with more info.

Larra

Larra do people get approved for the one they know will be covered and then try for the DS? I have heard different things. If so if you exhast your appeals would you have to reapply for the RNY or is it already still approved from before?

Listen to Larra.  Try what she suggests.  People appeal, fight, and win all the time.

And of course I wonder why you would go back to a surgeon who sold you on a bad procedure for a second round of bad advice.  Start over and don't settle for less.

Thank you so much you all. I am praying that if I get denied I will be able to successfully appeal. I am just so worried that its so close but I won't be able to grasp it. Thank you for the encouragement. I believe my doctor is one of the best in TX and I know he is skilled so that's why I want to go back to him. Also the fact that he did revisions on the TOGA and knows what to do. A problem was that a lot of doctors wouldn't touch me because of this and the ones who would wanted to charge double or triple. I even had a doctor in Mexico who didn't want to commit until he researched it and then was going to charge more than I could afford.  Thank you so much for your kind words of encouragement.

How close are you to 50 BMI?  I found out that I was actually 1" shorter than I thought I was and that pushed my BMI over 50.  1" height can make a big difference in your BMI.  You may be a little shorter than you were when you were younger.

My BMI is 43.

Have them recheck your height and learn to slouch a bit.  I would do anything it takes.  Don't settle!!!