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sonia8338
on 7/29/10 1:14 am
Topic: RE: CIGNA in NYC questions
Wow. thank you for this info. How is your VSG going? THanks....
Peace and Love
Lisey is my Angel



(deactivated member)
on 7/28/10 9:09 pm - Brooklyn, NY
Topic: RE: Greetings from Brooklyn
Wow thanks for all the feedback everyone.  I'm in for a journey. But it's all about getting healthy.
rbb825
on 7/28/10 2:52 pm - Suffern, NY
Topic: RE: 4 PLUS YEARS OUT!!!
I am sorry to hear you are having trouble with your band and that you havent' had alot of success with your weightloss.  I have heard alot of people with the band have trouble especially with there esophagus.  Have you every considered revising to a Gastric bypass to finish your journey and continue your weightloss?

 

MikeyMike
on 7/28/10 12:23 pm - New York, NY
Topic: RE: Dr. Cole Said No!
I loved my Doctors...Although they are in Long Island and they do the Sleeve.

http://www.newyorkbariatrics.com/


   Highest Weight: 380                      Consult Weight: 357             Surgery Weight: 309 
Goal Weight: 220 (9/29/10)      Revised Goal Range 215-220         Current Weight: 224
Plastics: Circumferential Lower Body Lift - 11/18/2011
              Gynecomastia - 6/14/2012

MikeyMike
on 7/28/10 12:12 pm, edited 7/28/10 12:14 pm - New York, NY
Topic: RE: Greetings from Brooklyn
Good Luck...Make sure that you research your options and are fully prepared for this.

This website is a great resource and I have found that people are very open to sharing thier experiences.

I would also try to attend some of the support groups. It was a requirement for my doctor to go to one session before and after surgery. To my surprise I love going and make sure that I don't miss a meeting.

Please reach out to me if you have any questions.

BTW...Long Island says hello


   Highest Weight: 380                      Consult Weight: 357             Surgery Weight: 309 
Goal Weight: 220 (9/29/10)      Revised Goal Range 215-220         Current Weight: 224
Plastics: Circumferential Lower Body Lift - 11/18/2011
              Gynecomastia - 6/14/2012

MikeyMike
on 7/28/10 12:04 pm - New York, NY
Topic: RE: CIGNA in NYC questions
Here's Cignas policy on Bariatrics.

http://www.cigna.com/customer_care/healthcare_professional/c overage_positions/medical/mm_0051_coveragepositioncriteria_b ariatric_surgery.pdf


They do require a 6 month "Program"

I did the atkins diet and had my Primary doctor signoff on my progress. I saw him once a month for an office visit that included my wieght.

I created a spreadsheet that had my wieght, What excercise I did.

Here's an excerpt from the policy:

 

Coverage Policy

Bariatric surgery is specifically excluded under many benefit plans and may be governed by state and/or federal mandates. Please refer to the applicable benefit plan document to determine benefit availability and the terms and conditions of coverage.

Unless excluded from the benefit plan, this service is covered when the following medical necessity criteria are met.

CIGNA covers bariatric surgery using a covered procedure outlined below as medically necessary when ALL of the following criteria are met:

The individual is 18 years of age or has reached full expected skeletal growth AND has evidence of EITHER of the following:

��

a BMI (Body Mass Index) 40

��

a BMI (Body Mass Index) 35–39.9 with at least one clinically significant comorbidity, including but not limited to, cardiovascular disease, Type 2 diabetes, hypertension, coronary artery disease, or pulmonary hypertension

Page 1 of 40 Coverage Policy Number: 0051

minimum of six months without significant gaps. The weight-management program must include monthly documentation of

Programs such as Weigh****chers®, Jenny Craig® and Optifast® are acceptable alternatives if done in conjunction with the supervision of a physician or registered dietician and detailed documentation of participation is available for review. For individuals with long-standing, morbid obesity, participation in a program within the last five years is sufficient if reasonable attendance in the weight-management program over an extended period of time of at least six months can be demonstrated. However, physician-supervised programs consisting exclusively of pharmacological management are not sufficient to meet this requirement.

• A thorough multidisciplinary evaluation within the previous 12 months whi*****ludes the following:

ALL of the following components:

��

weight

��

current dietary program

��

physical activity (e.g., exercise program)

��

an evaluation by a bariatric surgeon recommending surgical treatment, including a description of the proposed procedure(s) and all of the associated current CPT codes

��

a separate medical evaluation from a physician other than the surgeon recommending surgery, that includes a medical clearance for bariatric surgery

��

unequivocal clearance for bariatric surgery by a mental health provider

��

a nutritional evaluation by a physician or registered dietician

• Failure of medical management including evidence of active participation within the last two years in a weight-management program that is supervised either by a physician or a registered dietician for a


   Highest Weight: 380                      Consult Weight: 357             Surgery Weight: 309 
Goal Weight: 220 (9/29/10)      Revised Goal Range 215-220         Current Weight: 224
Plastics: Circumferential Lower Body Lift - 11/18/2011
              Gynecomastia - 6/14/2012

mollypitcher08
on 7/28/10 12:18 am
Topic: RE: 4 PLUS YEARS OUT!!!
Hi Kenny! I am just now reading the board! I don't post on here anymore much as it seems that there are fewer and fewer posts anymore! DOn't know where everybody went but I do try and post on OH 's main forum!  I am sorry you are struggling but admire the fact that you are still determined as IMO that is at least half the battle! Best of luck to you!! You will do it with your attitude!  Sorry too, about your health problems but it sounds as though you have a handle on those too and perhaps things will now start to fall into place for you.  I am just about 2 years post RNY and am just now struggling with increased appetite(food is tasting so much better these days!! so I have put on about 4 #.  I am working on getting that off and starting to drop weight again as I have not met my goal as yet.  (I have lost 200# but would ideally like to lose another 60-70#.  If it happens,fine, if not, I am happy with myself for losing what I have.  YOu should be happy also.  I guess what I am trying to say is you've done well, pat yourself on the back for the good you've done, you are healthier and now (like me you have a goal to work for and you can do it!! Hang in there Kenny - and try the main forum for support - they are great there and I also believe there may be a board for banders also.  Take care  Mary
Kenniestrek
on 7/27/10 8:43 am - NY
Topic: NY boards not what they once were!!!!!!!!!!!!!!!
I posted on here over two weeks ago seeking support!  WOW 64 people looked at what I had to say and no one took the time to comment!


Looks like there is no more  support here!

Bye all!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
Father Don
on 7/26/10 1:25 am - Charleston, SC
Topic: RE: Anyone from Suffolk/Nassau County, LI, NY??
There is a gorup called LIPO (Long Island Post Ops)

They have acitvities they do monthly - some are well attended, other not so much....

I would look them up on on the group boards - they are always welcoming new people.  And I think you might be able to find an exercise partner....maybe even my Fiancee!!!!



Obesity Help Support Group Leader
 

solise
on 7/25/10 7:59 pm - Brooklyn, NY
Topic: RE: Greetings from Brooklyn
Hi.
Yes the process is approximatly 6 months and could be longer if you miss one of the visits with the nutritionist. you have lots to do. 6 month nutritional evaluation, PCP letter of necessity, sleep apnea test, all kinds of bloodwork, psych evaluation. Good Luck on your journey. 

*Solise*
  2 years, 3 months out from my RNY     
                
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