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Sorry you got denied. I have read other post of people with the same issues with their insurance co. You might want to post this question on the revision forum as well.
Hopefully they will approval after the peer to peer. Keep us posted.
I had the lap band placed in May 2006, everything went well and I lost about 90 lbs. I started to have pain at my port site and noticed I no longer had restriction so I went it have it checked out. After the EGD it was discovered I have erosion. All pre op requirements done according to fepblue, but denied due to non compliance. So after 2 submissions to the insurance company now my surgeon has a peer to peer scheduled for tomorrow 1/2/14. Praying everything goes well.
Anyone have this type of experience?
Hi chinamomma I have fepblue and was also approved for the lap band removal but denied the RNY. My surgeon is also having a peer to peer review this Thursday. From your ticker I'm assuming your peer to peer resulted in approval?
T
As we welcome the 2014 New Year, it is a good time for reflection and renewal. OH's Goal System is a great way to start the New Year.
What are some of your goals for 2014? Share your goals here and post them in the Goal section of your profile. With the OH Goals System, you can make your goals private or public so other members can support you.
Let's reach our 2014 goals together! ![]()
Can someone please help me write my appeal letter?!! I have been denied because of my weight in 2011. I resubmitted new documents from my pediatricians office showing i was over 35BMI but they still are upholding their decision of denial. I am going for a second appeal now... SOMEONE PLEASE HELP ME !!!
I don't know if you will get this. But I need help with my appeals letter!
I have cigna...also been through 500 million diets.
I did have to got through three month consultation with a NUT. I was on the border like you.
In this 3 month consultation period you learn a variety of techniques and issues regarding the surgery. For example, taking 30 minutes to eat (not 10 minutes for food and 20 minutes for fun/doing the dishes) concentrating on hunger and fullness, smaller sized plates, spoons and etc, learning to eat and take medications wihtout a beverage, and chewing the food to 'applesauce consistency."
Learning and practicing these techniques over the 3 month period permitted me to make these a habit and to prepare my home for my new way of eating (e.g. out with the gigantic plates/bowls, in with really small spoons (for feeding infants) and dip bowls to become my regular bowl).
I would have been overwhelmed if I had to do/learn this all at once. As a matter of fact, this time is the second time I have considered WLS. The first time I considered it...it required too much change, too fast, with minimial guidance. With the group I am with now, they seem to warn you that a change/new technique/test is needed at one appointment..tell you to actually do it at the second appointment...and see that you have followed up on the third appointment. I like it. If you are like me and need some time to "wrap your head around things" and how they are going to be and impact your life....a warning that you have to do/learn/accomplish something is good. It allows someone like me to contemplate it, wonder how I am going to do it, research it, and give it a "few trial runs" BEFORE I have to do it with consistent perfection.
It is nice.
So now, at the second time around, I am not nervous or scared. I have executed all the techiques/ways of eating wiht success for two months beforehand. I have already got the supplements all purchased in the cupboard.
I feel confident, sure of myself and sure of the course.
And the three months have made all the difference.

RNY Surgery: 12/31/2013;
Current weight (2/27/2015) 139lbs, ~14% body fat
Three pounds below Goal!!! Yay !
on 12/27/13 3:56 am
If you fall below the 40 BMI, then the persons processing your approval could decide that you are not eligible. There is no guarantee either way. I was careful not to go below 40 BMI on my pre-surgery diet.
I believe that Cigna switched their requirement from 6 months to 3 months in May of last year (or sometime close to May). So that is probably why you're seeing all the 6 month info - its a relatively new change. I also didn't have a PCP before this started. I asked some coworkers and found one that was nice and set up the monthly appointments with her. She was also very understanding of my need to do the weight management program without losing any serious weight because of the BMI criteria. I don't know if your obgyn would work or not, but you could call Cigna and ask. My surgery program does require a letter from my PCP (its actually a form they have to fill out) recommending me for surgery and sending copies of any recent labs or tests. I just keep asking and asking questions of everyone I interact with so that I don't miss something. I'd rather be the squeaky wheel now than get disapproved later! Fingers crossed that works out!


