Cigna HMO FL -- Need advice

Please read below my recent main board post.  Cigna HMO of FL is requiring me to begin a brand new 6 months of dr documented weight loss and I need to fight it.  It's majorly medically-necessary, which they do cover.  I have a BMI of 81 and have at least 4 disease conditions.  I am willing to pay an attorney if I can overturn this stipulation with their help. My Post:

Hello all,

Please talk me down from the edge here.  Met the dr for the first time.  He says I need to lose 50-60 lbs before he can do lapro.  My weight is all carried in the front of me, my stomach and abdomen, and it's alot of weight.  My stomach wall is too thick he says.  He wont do open because he doesn't feel I'm in desperate need and that method is so much more open to complications such as clots, infection, etc plus the large scar.  My diabetes with meds is stable, as is my hypertension.  I have had cellulitus in my lower legs and have circulation problems.  I get around fine on an average daily basis, work an office job 8-5, live my life ok... basically just don't ask me to stand long or walk very far.  Maybe I should be glad he won't do open if not necessary in his opinion.  Unfortunately, it just really has me bummed.  Literally too big for weight loss surgery.  Great.   

Insurance then says I need 6 consecutive months documentation from primary listing weight, diet plan, and exercise performed.  My primary's scales haven't been able to weigh me ever (10yrs+) and they only saw me every three months to discuss my diabetic blood work.  So, I basically have to start a new 6 months now (my primary finally has digital scales), get on some plan, and have it documented.  Of course, the whole argument of why would I need surgery if I could do it without, is running through my head, but I guess I just have to do it. 

I was so ready.  I was so hyped that I had made this big decision and now it feels like I won't get it for a long time now.  I'd be willing to do 'protein only' for two months and lose his 50-60 lbs (his suggestion) but then I have to wait 4 more months to get the rest of the documentation.  Jimmeny!  I have at least four of the common morbidities.  I have a BMI of freakin' 81!  I can't stand or walk more than 15-20 minutes straight.  I need this done.

Oh, and how do I lose the weight the dr wants without looking too successful in the primary's documentation?! 

I have Cigna HMO in Florida.  Any suggestions?  Any chance that I could find anyone who would personally look at the facts and see common sense?

Thanks for reading, Karen

Sorry but you are going to have to do the diet with CIgna, there is no way around it that my office has found.  Also, make sure it is close to 180 days long from beginning of documentation to end. We had a patient get denied because it was 165 days long. You cannot tell me that your BMI just got to 81, you really needed this surgery several years ago, and another 6 months will not change that. Maybe you just realized you want the surgery and like all the rest of us, you want it yesterday. I'm not trying to be harsh, just honest. I was just like that before surgery and see it a lot on these boards. Many of us thought about WLS for years, finally come to a decision to have it and then realize it can be almost another whole year to surgery! You can do this....focus on making the lifelong changes you need to do , like not drinking with meals, it's harder than you think and takes a lot of practice. GOod luck! Bonnie

Um..., gee, thanks bonnie, but never said my bmi hit 81 overnight.  It was more of a matter of yes, finally deciding to go this route and being excited and ready to get on with the change, which also does not mean I was deluded or anything that this option would still be alot of work.  Thank you for the information that was helpful in your post, the 180 days.