Recent Posts
They may have you on the 1st issue, too. Make an appt today to have a weigh-in on March 14. That way, you can show 90 days (3 months) of monitored weight loss/weigh ins. Right now, since you started on December 14, then January 14 counts as a first full month, February 14 counts as a 2nd full month, and March 14 will count as your 3rd full month.
Also, are you sure that your psych eval results were included in the packet? If not, get it in now. Same with your PCP.
Hopefully, with your BMI, they might let you go through without technically meeting all the requirements. But, honestly, I think they will initially deny you until you meet all their steps. So, that means resubmitting right after March 14.
Good luck!!! I know it is so frustrating!
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)
Hello All,
This is my first post. I just joined ObesityHelp and I am thrilled to be here!
I am trying to get approval from CIGNA for a VSG. I am 22. My BMI is 57 and I've met all of the requirements by CIGNA. I did 3 months of weighing in starting on December 14, 2012. My second weigh in was January 21, 2013 and my third was February 22, 2013. I lost 9 lbs overall. I gained a little over Christmas and in January, but lost that weight +9 additional pounds. Anyway, I also was being monitored by a dietitian, and a psychologist. I had a psych eval and passed with flying colors. I had also initially talked to my PCP on October 25, 2012 about wanting to get the Sleeve and about what my options were and she was very supportive. So on February 22, 2012, my paperwork was faxed to CIGNA.
I have been calling them every single day (sometimes 2X a day) to follow up on the status of my claim. Well yesterday, March 1, 2013, I found out that my claim was being passed on to a medical examiner for revision. So that means the CIGNA nurse denied it initially. The basis for her denial was this:
-I did not meet the 3 month weight loss monitored program
-I did not have a psych evaluation
-I did not have a letter from another doctor giving me approval for the surgery such as my PCP
So, I know the first 2 reasons are not valid and can easily be sorted out. The third reason is completely my fault. I thought the weight loss center would contact my PCP to get the letter for the packet before they submitted the request to the insurance...they did NOT do that. I'm freaking out here. I was told the medical examiner would review my claim on Monday or Tuesday of this next week. I know that if I do not have the letter from my PCP that my claim will be denied. If I can manage to get the letter to CIGNA via fax from my PCP then there's hope, but I'm scared that it won't make it to CIGNA before my claim is denied.
I was wanting to get this surgery on my spring break because I'm a teacher and that would give me plenty of time to recover before school starts back up.
Is there anyone out there can give me some advice? I really need it.
Best,
Lindsay
That's too bad that investors will pull out before funding. It gives me renewed hope to know this is an option though, so thank you very much!
Hello, and thanks for your reply!
I guess I should have said that I'm not sure if I will qualify for a loan with my bank or a credit union. That would absolutely be my first choice! I have until October (when I get some vacation at work) to pay down my credit card and get my credit up, and that's when I will apply. But I've been looking into other ways to fund a loan in case I can't get a loan that way. I am VERY wary of the medical loan companies and I have read a lot of horror stories.
Prosper is a "peer to peer" lending service where you basically apply, and the "investors" on the site can choose whether or not to fund your loan, so while there are fees associated, I think it sounds better than the medical loan brokers. I just don't know whether the investors ever choose to fund loan requests for surgeries (especially in Mexico...).
Sleeved 6/12/13 - 100 pounds lost to get to goal!
Wish I had more options like you. Roslin just went out of network for me too. Best of luck.
Hockeymom87 · 0 replies · 628 views
