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Staff and attendees had a great celebration at our recent 2013 ObesityHelp Conference. It is so much fun to be with other pre-op and post op WLS'ers.
Bariatric surgeons regularly hold patient reunions for their patients. If your bariatric surgeon has an upcoming Patient Reunion, please reply to this post with the surgeon's name, date and details so other patients of your surgeon can be aware of the upcoming get-together.
I have been denied twice by Cigna. First was because the In-Network doctor submitted a claim to a non network facility. We got that straighten out. Now Cigna has come back again to say I was denied me for the sleeve for the following reasons:
They say medical necessity has not been established because:
1. The documentation submitted does not confirm that technical failure has been demonstrated on upper GI and EGD.
2. the documentation submitted does not confirm that due to technical failure of the original bariatric surgical procedure you have failed to achieve adequate weight loss as defined above at the least 2 years following original surgery (I had the lapband surgery that never worked for me)
3. The documentation submitted does not confirm that you have remained fully compliant with the medically prescribed postoperative nutrition and exercise program.
The doctor is going to attempt a peer to peer review, should I do anything else? The lapband didn't work for me. I have high blood pressure, my PCP submitted a report showing my heart is affected by the high blood pressure. I have tried everything imaginable to try to lose weight and I can't keep it off. I even bought a dog to walk only to find that I could walk about couple of blocks before hip started to hurt and feet went numb. I just don't know what to do at this point.
If someone could guide me so I can get approved.
Thank you!
Gigi
I'm sorry no one replied to this. It really depends on each insurance company. For example, Aetna requires that the 6-month supervised happen within 2 years prior to the surgery. They have a 3-month option that they require happen within the 6 months prior to the surgery. It appears that BCBS's medical policy bulletin is silent as to the timing, so, you might make it.
HW: 274 | SW: 232 | CW: 137 | Goal: 145 (ticker includes a 42 pound loss pre-op) | Height: 5'4"
M1: -24 (205) | M2: -14 (191) | M3: -11 (180) | M4: -7 (173) | M5: -7 (166) | M6: -8 (158) | M7: -11 (147) | M8: -2 (145) | M9: -3 (142) | M10: -2 (140) | M11: -4 (136) | M12: -2 (134) | M13: -0 (134) | M14: -3 (131) | M15: +4 (135) | M16: +2 (137)
We LOVE NSVs. Check out this video on NSVs that contains some of our fellow OH members and speakers from the 2013 ObesityHelp Conference, courtesy of OH Member, Beth Sheldon-Badore. Inspiration for all of us as we live our healthy lifestyles every day.
What are some of YOUR NSVs?
I'd be broke with bills than live another year like this.
Lots of luck to you!
on 10/6/13 11:53 am
I will have a revision in February, too.I wondered about this as well, but I will still have my private insurance, so I think I will be ok. I need to get everything and anything done before things change.