Recent Posts

HarleysValentine
on 10/30/10 6:07 am - Orlando, FL
Topic: RE: 6 month diet/gained weight!?
Well I weighed exactly the same as last month (not sure how I lost those 3lbs that showed up!) BUT my personal vent is that I don't understand why we have to endure this for 6 months. If dieting worked for us than we wouldn't be opting for surgery (at least I wouldn't be).
 
In Mid-End of November I plan to submit for approval...My surgeon's office said they are scheduling surgeries about 4 weeks out so I will be able to get it around the first of the year if all goes well!
J. gale
on 10/30/10 4:53 am - Liberty, NC
Topic: RE: Denied by Cigna
Would it be an appeal or a resubmital of the application with all the documentation.
Frozenbooty
on 10/29/10 9:23 pm - Wasilla, AK
Topic: RE: I hate meritain
I did finally get my denial letter I will be appealing next week when my 6 month physician approved weight loss trial is complete fingers crossed
             
Frozenbooty
on 10/29/10 9:17 pm - Wasilla, AK
Topic: RE: 6 month diet/gained weight!?
I started my pre op diet before my last appointment because of this reason I realized I had gained 10 pounds somehow during the month before.... I dieted like crazy protein shakes and no carbs and lost all but one pound which my doctor didnt consider a gain. This time I have lost quite a bit because I just stayed on the diet very closely. I am almost concerned that maybe im losing more than I should but I am not gunna sabotage weight loss that will make me healthier during surgery.
             
Frozenbooty
on 10/29/10 9:13 pm - Wasilla, AK
Topic: RE: Denied by Cigna
I was also denied for this same reason with my insurance but Nov 3rd will be my last appointment for this 6 month go around and I will be appealing then. When I got the denial letter this week finally and realized this was all that was holding me up I am gunna try to appeal it.

My PCP has been documenting very carefully the last 6 appointments she has had WLS so she knows the ropes and I am hoping my appeal will go smoothly otherwise I will have to start another program for weight loss and wait another 6 months which might drive me crazy.
             
yasulh
on 10/29/10 11:14 am - Augusta, GA
Topic: RE: VSG or RNY?
The surgeon's suggestion is a suggestion, but ultimately it is your decision which surgery to have. If you want the gastric bypass, and you meet the criteria to qualify, I don't see why you can't get it. If your surgeon won't do it, I might talk to a different surgeon.

Good luck!

Tonia

RNY 11/15/2010

HW 280ish

SW (after 6 month diet) 247

Lowest post-surgery 183

Current 241

Considering revision to DS - have appointment 8/15/2017

yasulh
on 10/29/10 11:09 am - Augusta, GA
Topic: RE: Better after a good cry
I would talk with the surgeon directly about what you want to do, and get him/her to put pressure on the insurance person to submit the paperwork anyway. I would bet the surgeon would rather try and have the possibility of getting paid for the surgery than to lose you to another surgeon.

Good luck!

Tonia

RNY 11/15/2010

HW 280ish

SW (after 6 month diet) 247

Lowest post-surgery 183

Current 241

Considering revision to DS - have appointment 8/15/2017

J. gale
on 10/29/10 5:48 am - Liberty, NC
Topic: RE: Denied by Cigna
I thought you were talking about me for a minute... I am in the same situation... pre-cert denied, appeal denied all because the physician supervised program wasn't to their liking... my doc and surgeoun think its absurd but what can you do... I restarted a physican supervised program in August and hope to start over mid January.
tabbymom
on 10/29/10 3:18 am - Lee's Summit, MO
Topic: RE: Are nut & psych evals covered by Cigna?
I have Cigna PPO in Missouri.  My visits to the dietician and psychologist last week were covered, I just had to pay the specialist co-pay amount of $35 per visit.  I am a self-pay for the actual surgery, since I didn't want to mess with six months of supervised diet and exercise (and I want the surgery NOW, not in the middle of summer with lots of stuff going on).
Lori    5'2", HW 240, SW 207, lost 18 lb on the preop liquid diet, CW 168




            
Meghant
on 10/29/10 12:30 am - CT
Topic: Denied by Cigna
I am a little ticked I have been denied wls thru insurance provider cigna.  My BMI is greater than 40 and have 1 co-morbidity.  Well I knew they required 6 months of weight management supervised by a doc so I started a program at the surgeons office. However, I also did a weight management program back in 2007-2008 thru another doctor in which I lost 70 lbs.  I had all of these records forwarded to my current surgeons office.  I attended this program for about 8 months every week.  I kept a food log for the most part and doctor took notes and everything.  All of this information was submitted to Cigna along with all the other paper work they required including note from my primary care doc, psych eval, current nutrition visits etc.  Well I got denied.  The surgeon’s office did a peer to peer review but again they same doc or nurse reviewing my case still denied my request saying the weight management program I did was not in the last 2 yrs.  Which is one of their criteria.  Ok so I receive the denial letter and I saw the terms for the denial see below They mentioned the failure of a weight management program in the last 2 yrs as however, they went on to say of the person has long standing morbid obesity evidence of a weight management program in the last 5 yrs is sufficient. 

You mean to tell me they couldn't let a few months go for the 2 yrs?   Why wasn't my weight management program information sufficient for the 5 yrs?  I know it said long standing obesity but when i called Cigna for a definition of what they deem long standing I couldn't get an answer.  

 I am feeling a bit discouraged at this point has anyone run into this problem?  Is this the true stall tactic by Cigna.My next step is to appeal in January by then I will have completed the program at the surgeon’s office in which I was doing in parallel along with current submission.  I have also asked to receive some medical records from old doctors dating at least 10 yrs back.  I am going to see what happens next.
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