Advice about insurance/approval process please!

That is really encouraging to hear from someone else with Cigna and a very recent experience, thank you so much!

can I ask you a couple questions? How long did you participate in the required program? Did you do the 3 month minimum and then apply? How long did it take you from initial appointment to surgery? After the program, had you lost any weight and dropped below the 50?

i see you just had surgery on the 5th. Congratulations!! How are you feeling? How long would you recommend others to take off work/school after surgery? I'm a nursing student so my schooling requires once weekly clinicals that are pretty strenuous: lifting and helping immobile people move from bed to chair etc, and being on feet for many hours. I'm thinking because of this that I should have my surgery in the beginning of the summer so I have adequate time to recover and adjust. Would you agree? If I decided to have surgery during school I would be able to miss 2 weeks of clinical with a doctors note, no more.

thanks again!!! :)

With co-morbidities, in many plans, the required BMI is actually lowered.  Check your plan for those details, too.

I had a whole slew of co-morbs when I had my DS, including, but not limited to high blood pressure, sleep apnea, and GERD with Barrett's Esophagus (considered a pre-cancerous change in the lining).  I was put on Nexium for a year, then re-scoped, Barrett's healed, surgery six months later, since I had to do six months of pre-op classes and support group meetings prior to surgery, but not before the GI doctor cleared me with the Barrett's.

Try to have your surgery during school breaks, especially if your clinicals require heavy lifting - your abdominal muscles help you do that, as you know.  I'm assuming you're having lap instead of open, since most are these days, but take off the full 6 to 8 weeks *especially* if you're having open.  I started back to school for a different degree after my DS, and I am currently on a year's break after having medically necessary thigh skin reduction surgery.  I'm taking the spring off involuntarily, since information did not get where it needed to go in time for me to reserve classes.

Good luck to you!  Prepare to be amazed!

It took me about 5 months to get through everything. I had to do a three month medically supervised weight loss program, meeting with nutritionist, psych eval, and letter from my primary care physician clearing me for surgery. It took longer than I expected to get in with my primary care physician for the physical. I believe my BMI was 49 when I went in for surgery. 

I am feeling okay, but I definitely could not be doing any strenuous activity at this point. I have a desk job with an assistant and I've only been able to go back to work part-time. In your case, I would definitely try to wait for a school break. 

Hi Brie, I have CIGNA PPO too.

I was anxious and went to my first seminar in June 2014. Coverage didn't start until July.

Had my 1-on-1 with the surgeon on 08/21/14. (The surgeon was on vacation the whole month of July)

Had my psyche Eval the same day

Started my 3-month medically necessary weight loss visits in September. My last appointment was 11/26. (The day before Thanksgiving)

It was submitted to insurance on December 1 which was a Monday.

I was approved three days later on December 4th.

Did my preop testing on December 19th.

Now I'm just waiting to hear about when my surgery date is and if all was well with my preop testing.

I actually gained a little bit of weight because I had another surgery in between all this. (Water weight) But my insurance did not care. The surgeon does however. My surgeon said that I could not gain any weight and if I did she would not do it laparoscopically. But I am well over the 50 BMI. I plan to lose it before my surgery date.

Fear not, for behold (some Xmas humor).

I also have very good Cigna coverage thru work. My BMI was 40 on the dot, and Cigna mandates 50.

As you would expect, they turned down the surgery, then Doctor did a consultation which again Cigna rejected. My 2nd challenge to Cigna lead to a denial in the mail to me, but they called my doctor a few days later and approved. I had the surgery on Nov 10, 2014, and Cigna covered 42k out of the 44k surgery bill.

Apparently, the back and forth with the insurance company is a normal process, and it took about 5 to 6 weeks all in to be resolved.

Good luck, and I'm sure you'll be approved, even if they deny the surgery the first time out (which they won't at around a 50bmi). 

In a situation when the bmi is short from the approval.  I know plenty of people who have just gained the weight since it is so easy to do so. It's easy to gain 5 to 10 pounds.