sloppy joe

I currenlty have Humana ins but will be moving to Cigna as of Jan 1st 2012. My company is no longer offereing Humana going forward. I decided to have WLS after a visit to my PCP when she suggested I look into it after discussing my weight. To give full disclosure, I haven't been to a doctor in quite sometime (probably close to 10 years), I just don't go. Other than my weight I'm fairly healthy. My first visit to my PCP early Aug I asked her to run a full blood panel and do a full work up on me since I haven't been to the dr in a long time. At that first visit my blood pressure was a little high so she put me a low dose blood pressure medicine. When I came in on my second visit to review my blood work, chest xray, sonogram, everything was good. Cholestrol good, sugar level good, thyroid good, liver function good, ovaries look good, heart looks good, and lungs look good and the only comorbidity I have is lower back pain. So all in all I'm pretty healthy with a little bit of high blood pressure and lower back pain. Also In my second visit to my PCP I disucssed my weight, I'm 5'4", 320lbs, 56 BMI and I'm 40. I'm single, never had children and been overweight all my life. My PCP recommended I look in to WLS and gave me a few surgeons to check out. She documented that visit as the start of the physician assisted weight loss management program as she knew most insurances require 6 months. Based on her recommendation I checked out the one surgeon that she recommended that was covered by Humana and went to a seminar that he held on WLS and that's when I decided on the VSG procedure. I have since had two appointments with that surgeon's office (one actually seeing the surgeon) and essentially I just need to complete my 6 months weight management program, have a psych evaluation and get a letter recommending this surgery from my PCP and submit to Humana for approval in Jan 2012. Just last week my work announced they revised the entire medical plan and the 2012 is completely different. It looks like Cigna will be the ins that I will have starting 2012. Since I won't be completing my 6 months weight plan this year I will have to qualify with Cigna's Bariatric guildlines and here is how they state their weight management programs: "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 minimum of six months without significant gaps." So I shared all of that to say, what is considered failure of the physican assisted weight managment program? I'm concerned that if I show weight loss and given my current health history (I'm pretty healthy, i'm just fat) that they might deny the surgery in Jan when I have completed my 6 month program. I would like to make effort during this time to lose weight to help with the surgery (about 15 -20 lbs) but I'm really concerned that Cigna will deny me the surgery stating that I didn't fail in the 6 month weight managment program since I would have lost weight. I would think that my BMI alone would be enough for the surgery even if I lost some weight during this 6 month time frame. I just don't want to ruin my chances with the surgery. Any advice would be helpful. :-)

When I called Cigna last week they sent me their bariatric requirements (http://db.tt/6ScLpme Link to the document) which is where I got their exact phrasing about the "failure of medical management.." Now that I have had time to read this entire document I have additional questions and will contact Cigna again with those questions. I'm a cut and dry person and it seems like all of this is subject to interpretation. I appreciate all the replies and suggestions. :-)

I have attached Cigna's Bariatric policy. My work is changing from Humana to Cigna and I just called them last week to talk to them about WLS since I just started my 6 month physician assisted weight management program in Aug. mm_0051_coveragepositioncriteria_bariatric_surgery.pdf

I am fairly new to this forum (I have been lurking for a few weeks). I have decided to have the sleeve procedure done and I'm in month 2 of my pre-op weight management program required by my insurance company. I have already met with the surgeon that will be preforming the operation and have attended a wls seminar as well as the orientation required by the surgeon. I'm anticipating have this surgery Jan or Feb 2012 since January will finish my 6 months physician assisted weight management program. I'm 5'4" and currently my weight fluctuates between 315 - 320 and I have been heavy my entire life with right now being my heaviest. I'm giving you this history so it can help with the advice I'm asking for. Today I was approached by my boss's boss (two levels up) and he was talking about flying me up to Chicago to attend a focus group work session for a high level initiative that is on his plate that has rolled down to my plate. I don't have an issue with the initiative and am taking ownership of it (it has been on my plate for a month now) and I think it is a great opportunity. This initiative is still in the development stage and while it is in development stage we want to look at it from a global holistic perspective so it can be implemented across my organization as a whole. For more background info, I have been employed with this company for 18 years but I'm new (as of April of this year) to my current organization and I'm inline for a promotion come the end of the year. With that being said, I have a few concerns that I had hope I would not have to deal with until well after my surgery and after I had lost a decent amount of weight. I'm concerned about flying and if I would require to purchase a second seat. The last time I few was around 5 years ago and at that time my weight was around 280-290 and there were no issues. I didn't even need a belt extender, granted the belt was out as far as it could go and it took a little effort to clip it in but I managed. As I see it I have three options: 1. I can sit with my boss's boss and talk to him about my concerns and let him know that I might need two tickets in order to fly up to Chicago for this meeting (which will be really embarrassing) and also let him know about my involvement with this weight management program so he knows I'm taking steps to improve my health and this shouldn't be a concern in the future. OR 2. I can come up with a reason why I can't attend in person and see if there is an issue with me attending virtually (they are flying folks from all locations for this meeting, England, Tampa, NY...) so I"m not sure that will be an option. OR 3. i can take my chances and have the company purchase one seat for me and hope that I don't get asked by the airline (not sure which one it will be) when they see me about needing an additional ticket. I'm really torn as I don't want to ruin my chances of my promotion as well as I don't want the embarrassment of the conversation with my boss's boss regarding my weight. I know you don't have to be a rocket scientist to see I'm over weight so it won't be a big revelation. Also as we know those folks that haven't had to deal with a big weight issue are not aware of the things we deal with daily and I'm sure the thought of potentially needing to purchase two airline tickets for me hasn't crossed his mind. So I'm open to any advice that y'all can give. I leave for vacation on Friday so I need to talk with him tomorrow if that ends up being the decision. (I know this is short notice so I hope i get some replies). Thanks for reading.

Thanks again for the great advice everyone :-) @MeMeMEEE: I did some research and the seats range from 17"-18" (either of these are a tight fit) and I found a sight that provided which airlines used the 18" seats and I booked my flight with those. I'm flying American to Chicago and United home. I'm planning to arrive at the airport early to see if I can do an upgrade to business class and pick up that expense myself, if it is available. Thanks for all the words of encouragement. This is going to be a long journey for me and I keep telling myself that this time next year I will be much lighter and hope to be 7-8 months post op. I have been reading this message board every opportunity I have had since I made my decision for the sleeve (I was originally considering the lap band but after more research I decided on the sleeve) and there is a lot of folks sharing their success stories. I was surprised at how much weight folks are losing in the first year. All of these stories and post keep me motivated!! :-) Thank you,

Thanks everyone for the replies, I will be booking my flight to Chicago today for Sept 20 - 23. I"m on vacation starting tomorrow and I'm scheduled to return to work from vacation on the 20th. I'll be making my flight arrangements myself and hope a seat belt externder will be all I need (keeping my fingers crossed). If I have to purchase an extra seat I will pay for that on my own with my personal credit card. I just wasn't sure if I can use a different card then my corporate card to purchase the extra seat if needed.

I can't wait until I can contribute to this thread. I'm looking forward to experiencing all of these that have been posted. I just completed month one of my 6 month physician supervised weight loss program so I have a ways to go. So this time next year I will be able to contribute to this thread. :-)

I attended a lap band seminar today and someone mentioned that bcbs of Florida doesn't cover weight loss surgery. You might want to call them to verify and if that is the case it wouldn't matter if you complete the 6 month weight management with your pcp.