I have been on the journey since June 2013. I have done all my nutrition classes, my 90 day waiting period, lost my 10 lbs that was required. I completed all that on Sept 18. Now I waiting on the insurance company for approval. How long did it take you to get your approval? I have Aenta insurance.



Thanks Rose

Hi there! This is my first post, as I am just starting the journey towards weight loss surgery. I have done the research into my specific Cigna healthcare policy and they do cover weight loss surgery with some stipulations. The BMI requirement of 40 I meet, and the program I'm interested in meets the "thourough multidisciplinary evaluation" criteria.  The one criteria I'm concerned about is the 3 months of medically supervised weight management program. I have done so many diets and exercise programs I can barely count them anymore, but they were always supervised by a trainer at the gym or I kept track of calories with an online program - never a physician or registered dietitician. I have no problems going through 3 months of a program like this, but my BMI is right around the 40 limit (5'6" and 250lbs).  If I lose more than two pounds on this medically supervised program I'll fall under the 40 BMI requirement and be ineligible.  My question is, for Cigna's 3 month weight management program do you actually have to lose weight or just show that you've participated?  I really need this surgery or I fear I'll forever be in the cycle of losing 20-30lbs and gaining 40 over and over again for the rest of my life. Does anyone have knowledge or experience with this same situation that could offer advice?

 

Thanks!

- Lucy

So my insurance Aetna HMO was excluded with no hope and now has 'unless HMO approved' tagged at the end of the sentence.  I would guess they would grant surgery as a medical necessity, but in those cir****tances would you still have to go through all the normal requirements or be able to just bypass with letters of medical necessities.

     I feel I have a strong chance of getting an approval.   I am 28 living with sleep apnea, have been using a CPAP for a few years, and as of August, having a DVT(Blood Clot) in my Right leg still on coumadin/lovenox regiment with PT/INR testings.  Also have pain with knees and have x-rays of bilateral arthritis.  Nothing but gyno issues, no longer having periods(not expecting), which is better than my periods of floodings.  I have a gammet more of issues reflux included. 

     Just wanting to see if anyone has Aetna with exclusion unless HMO approved and how it went. 

            I am going next Weds to an information session where I am sure they can explain all the insurance dealings.  Hoping for Duodenal Switch surgery...I really don't want to be 350 lbs. 

 

 

My boyfriend had to file for bankruptcy last year due to losing his job and insurance and then having to have some surgeries and hospital stays. He can't seem to find anyone to give him a loan. Does anyone know how he may be able to do this? Or does anyone know of a surgeon who offers financing through their office, or know how to find one? (not care credit as he doesn't qualify) please help....he really needs this surgery. He has a good job now but his insurance doesn't cover it.

 

Denied by UHC-for the second time and for the same reason.  I don't have 3 years of medically supervised weight Loss under my belt.  I don't understand the denial.  I had a wonderful appeal letter and my doctor wrote to say this would save my life.  But-I am not upset on the denial so much as upset at how they did it.  The first appeal was to be done by a independent doctor in a related field.  You want to know what the doctor's related field was???? Cardiologist and thyroid specialist.   REALLY?????  How related is that????    I am so mad I could spit!!!!  How do I do this second appeal.  I tried to show I had all these years of trying to diet.  I showed on paper I had years of different diets, weight loss products, medications-but no!!!  This insurance states that it has to be 3 years consecutive medical supervised weight loss program.  What do I do???  I can't think, I can't feel anymore.  I am willing and ready for the fight, but I don't know if I will just hear the same answer again.  Anyone else dealt with this?  Any information would be helpful.

Thanks so much

Linda