HELP!! Need Dallas dr. and insurance specialist help. Got 2nd denial from cigna

lovemyhorse
on 11/7/13 2:48 pm

I have had a lapband for 10+ years. I have never had any luck with losing any weight with it and the past 3 years it has been very painful due to scar tissue building around it. I have 3 years of visiting my Primary care dr with stomach pain, chest pain, and reflux. Spent thousands on tests and office visits + EGD and barium swallows trying to figure out why the band hurts so bad. No slip, no erosion, just hurts like a madman. I now weigh exactly what I did when I got the band with a BMI of 35. I have insulin resistance (but not diabetes yet) high blood pressure, reflux, sleep disorders, hypo thyroid issues, serious depression, shortness of breath, and very high triglycerides. All of these conditions require 7 expensive meds a day plus therapy and counseling for the depression. My primary care dr. has written letters to CIGNA practically begging them to revise from band to sleeve. My surgeon, who put the original band in, has asked for the okay to revise. Yesterday Cigna reaffirmed their decision to deny based on (are you ready for this) #1 There has been no evidence that there has been a mechanical failure of the band and #2 Weight loss surgery is experimental for the treatment of diabetes. I DONT HAVE DIABETES AND THE DR NEVER SAID THE BAND HAD A MECHANICAL FAILURE. I only have until the end of the year and then my husbands insurance changes to where we will no longer have WLS coverage. At this point I would love advice and recommendations for which Dallas area doctors can get fast new patient appointments and most important who has the best, most experienced insurance approval staff? I am so frustrated with this. Badly need help very soon.

hollykim
on 11/8/13 5:25 am - Nashville, TN
Revision on 03/18/15
Hate to bear bad news,but it. Looks like there DOES have to be show a mechanical failure of the band. If that can't be proven then they are assuming you ha e not followed the program and the failure is yours and not the band failure. If there is not a band failure proven,they won't pay to have it out.
Unless your tests show a slip or erosion or something they are not. Going to pay.
I am not saying you ha e or have not failed the band,I don't have a clue.

Going on what you have said here,that is the way it looks to me.
GL

 


          

 

Virgie Tschirhart
on 11/10/13 2:29 am, edited 11/10/13 2:29 am - Midwest City, OK
RNY on 12/27/17

Just letting you know my experience, I too had the LB revised to the Sleeve and my reflux became worse.  Not sure if you know that RNY is the less likely for reflux.  I have a hiatal hernia too.  I am waiting for my doctor's office to submit the paper work to BCBS Federal.  

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

sweetadanhunnie
on 4/1/15 10:05 am - Grapevine, TX

I just started the process with TrueResults.com. They have several clinics throughout DFW.  

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