Question:
How do I begin the process to have weight loss surgery?

I have insurance and have contacted two facilities. One I told me to call my insurance myself. I called CIGNA: they said it's not covered but I've read on this site where CIGNA has approved the surgery. I sent the other facility an e-mail and have yet to hear back from them. Please advise me on how to get this ball rolling. I am in Raleigh, NC. I desperately want my life back!    — hallmon (posted on November 21, 2009)

November 21, 2009
First, you need to ask around and find a reputable bariatric surgeon or weight loss center....preferably, a "center of excellence." THEN you give them a call and find out when they will be conducting a seminar...which is an information session, basically....about the surgery and to address any questions that you may have. After the seminar, you need to schedule an appointment and they will guide you from there. My doctors office submitted my insurance claim for me. You just gotta jump in there and start asking questions....just like you are doing now. This site is a valuable reference source, so you have come to the right place. Also, your primary care physician should be able to recommend a good bariatric surgeon or center of excellence for you. Good luck!
   — PaulaJ

November 21, 2009
I had Cigna Insurance and they covered the surgery. BUT, whether or not they cover it actually depends on your employer. Your employer doesn't HAVE to opt for Bariatric Surgery coverage. I was actually scared to ask my insurance, so I scheduled a consult with the surgeon (which was free), and he had his office insurance specialist call Cigna for me. We found out that yes, they covered it, but with conditions.... one was that I had to have a six-month, physician supervised diet with monthly appointments and progress reports; OR I could go on a THREE month dietary trial supervised by BOTH my physician AND a registered dietician. But either way I chose, the documentation had to be monthly, and precise, with labs and weight documentation, and which diet I was on, and whether or not we tried different diets, etc. And even so, I was denied at first. But, it turned out that all they really wanted was a short conversation with my PCP, so that she could tell them she really felt that I was committed to this change in my whole way of life, and that she would be there to support me as well. After they talked to her, I was approved in two days. I literally got the denial letter on a Monday, and the approval letter on Thursday. It may turn out that your particular CIGNA plan really does cover it, but with similar restrictions. Or, it's possible that your employer doesn't pay for that option. Like the previous poster said, call around first, find a surgeon who is connected with a Bariatic Center of Excellence, go to his or her seminar, then schedule a consult with the surgeon's office. Or even this.... first CALL the office and ask to speak with the insurance person, and ask that person if your insurance covers the procedure. She's likely to know right away if they do or don't, or can find out for you within a day or so.
   — Erica Alikchihoo

November 21, 2009

   — Gail T.

November 22, 2009
As another poster said, it is possible that the surgery would not be covered because your employer created an exclusion. Because it is considered "elective" surgery, the employer can chose not to cover it. I also recommend getting the boook "Weight Loss Surgery for Dummies". It has a lot of really helpful information that you can use to discover what you are getting into with surgery and what the process is like and it also gives you good tips on the kinds of questions you might want to ask whoever ends up being your doctor.
   — ads2e

November 23, 2009
I don't have CIGNA but the first time I contacted my insurance company I got a great person who read my policy info correctly and said normaly it was excluded but in certain medically neccessary cases is was approved. My doctors office contacted my insurance and got the wrong person so I had to get proactive and contact them again and encourage the person to keep reading and find the exception to the exclusion. Also my insurance only covered the RNY and lap band and I wanted the VSG and my doctor was able to get the VSG covered by stating that it was the 1st stage of the RNY. There are challenges to face but I am down 88 lbs in 8 months and I am feeling great. Keep pressing forward and look into all you can.
   — Lisa von Wallmenich