Sooverit!

Dear Deb: Thank you soo so much for sharing your victory with me. I am waiting for something in the mail from Walter at ObesityLaw. what a great service. I am so happy for you! Keep us posted! fonldy, marg

Hi Margo, I tried to post this to the group, but since I'm new, I'm not sure if I did it right, or if you'll see it, so I decided to email you. This is such important info for you (I feel:). I also have Cigna and was under a 40 BMI with some co-morbidities that I thought would qualify me. However, Cigna decided that since I was responding to my meds, I shouldn't qualify. However, thanks to a free-to-us advocacy service, that the manufacturer of the Lap Bands pays for, the attorneys there dealt directly with Cigna after I was denied and after another denial (expected), I was approved!! Cigna is a stinker, but these people are my new heroes! They've worked with them so much they are unbelievable!! Just go to ObesityLaw.com . The attorney that runs it has had a band and knows how we feel! His name is Walter Lindstrom. Kelley Brown Lindstrom is the one that I worked with. I didn't have to do a thing but send her all my info that the surgeon's office had submitted to Cigna. The whole process after my first denial took about 6 weeks. They are wonderful! I was approved on Tuesday of this last week, had my pre-op appt. on Wed. (they had a cancellation), and I'm scheduled on May 8th for the surgery! Let me know if you need the contact info for them. Maybe I'll figure out how to post on this site!! Good luck! ~Deb

Thank you so much Kathy for understanding. It was my co mobidity issue - not that I don't have any...as many as anyone carrying 90 extra pounds and strong genetic predisposition for obesity related illnesses! I am currently in the process of an appeal. It seems like Cigna is saying no now but after a few appeals they cave in and issue an approval...I'm hoping?

Anyone banded by Dr. Powers yet?

Cigna put up your dukes...wow haven't said that in decades

1. Why am I sad? Cigna turned me down after over a year of working on going through all the hoops while others get covered at the drop of a hat. 2. Why does not being covered by insurance make you sad? Because I feel like the universe doesn't think I deserve this...but boo hoo. maybe I just need to work on this more and make sure I'm ready for this lifestyle change and giving up of a very strong food addiction. Sad I really shouldn't go into debt at this time. Sad that I may die from being overweight and leaving my young daughter w/o a mum. Sad my sister died this way. 3. Why is death sad? Leaves people with a hole in their heart some time, not to mention big life disruption as well as a missing role, eg. missing parent, sister, grandma/pa. . 4. Who do you see passing soon? Ahh...hopefully not me, my daughter's only 11! 5. What can you do ? 1. Go to Mexico....though maybe too stressful to fly lately after a proceedure like this....2. Fight with Cigna more...fun. Get a equity loan and spread it out over 30- years. 6. What is stopping that from happening? I'll be lucky to get the loan and in 30 years I'll be 80 but husband could pay it off for me....Could get my neice to come w/me to Mex but always feel sick after being a plane lately.

Lucy sorry for your grief....it's like we are being penaltied for not being heavier! I was turned down with a 39 BMI.....I thought I was loosing my mind when I read your heading though...I thought I wrote it. My only son goes to UMASS and my only daughter attends Norwood School!

Dear VV: I'm almost twice your age and have a river of pain and tears behind me. You are so wise for your age, to be this much in touch with your feelings is amazing. Firstly I think you should not feel guilty for how you are feeling. Birth and or growing pains hurt and you are in the process of birthing a new you...hang in there, keep breathing, take soothing baths, get rest and trust that this too shall pass and you will be a strong wonderful adult who doesn't need food to stuff down the emotions any longer. Be strong ....it'll all be worth it!

Hey Jena: I think you hit the nail on the head as to why people have an issue with CIGNA As you stated :"Because the coverage said explicitly that it would not be covered, there was no getting around it. Period. End of story" I called Cigna numerous times before I went down this path and they are very secretive and sort of sneaky and won't be firm in their decisions. They never told me what I was told in the denial letter because they know if folks out there know exactely what to do to get covered they will. They cover some people who are under a 40 BMI while not covering others who do have a 40 BMI. (for a year) They are certainly not consistent at least the Point of Service covereage!

Believe it or not I rushed into this It's taken me almost a year and a half of work but it's over at least. This...meaning insurance approval with Cigna. I was Denied because I was shy a 40 BMI by 10 -12 pounds when I submitted everything they were looking for I jumped thru every hoop and paid out every last cent to docs. etc. but I should have know (and not listen to people on this site that said Cigna does cover with no co mobidities - NOT TRUE) they clearly state that they do not cover those under a 40 BMI unless you have grave illness that don't respond to meds.. Not only that but they will not approve any claim even related to this one in the future. Meaning if I gain 10 pounds in the next year.even if I maintain that for a year and..easy to do at my age...they won't even consider it. My fear is of dying of a heart attack like my twin sister did of obesity last year. My chest is so huge it strangles me at night and causes sleep apnea that doesn't appear on the "test" ...another few hundred bucks there. My warning to those seeking insurance approval with CIGNA....if you're not starting out with a 40 BMI save your money until you are or get a loan unless you can clearly prove a comobidity. __________________

Well I was 7 pounds shy of being covered and I will never be able to be covered by Cigna any time soon. I feel I should post their letter to me dated March 31, 2008 After review of the information submitted by your provider and the terms of your benefit plan, we have determined the requested services are not covered for the following reason: Body mass index should be greater than 40 for at least one year and or BMI is between 35 and 39.9 for at least one year and the patient has one or more documented clinically significant co-mrbid conditions (1) that have failed to respond adequately to non -surgical treatment methods including appropriate and adequate medication; I think with Cigna the big 2 they will cover the Lap Band for are sleep Apnea and Type II Diabetes and or High blood pressure. But again they may only cover these if they don't respond to med or machines~ Also they threw in the middle of a long paragrah "Any claims associated with the denied request will not be considered for payment" period!

I appologize if this is a dupe ...Not sure if my second post showed up. Re. being denied by Cigna, I meant to say that be sure you have a co mobidity with Cigna that they approve of. I had over a half dozen but they are currently managed with meds. Also some folks who have a BMI of 40 still get denied. I may appeal but just don't want the costs and headaches right now.

I really notice the difference in my appetite when I eat healthy foods ...lately (I'm not banded) that means most foods from Trader Joes. I'm much less hungry when I eat fruit, veg juice, lemon in Water...luke warm...cold just doesn't go down as easily. Start by forgetting about weight for now and focus on what makes our bodies healthy. Marg

I meant to say that you should be able to clearly substantiate the co mobidities that CIGNA specifies. I had almost a dozen "co mobidities" but they are in check with meds. I hear of those denied with a 40 BMI as well. I could apeal their denial but that is going to cost money and headache and :cool:I'm just not about to give out anymore.

Dear georgia girl: You are a sweatheart and a very kind person. I hope this doesn't sound odd but when I saw your picture I was stunned at how much you looked like my beautiful sister when she was young. I have been thinking all day...that I could either Switch Insurance Companies, get a loan, or lose the weight on my own. All not easy choices but maybe the loan part could be the most viable. Though I'm in no position to be in debt. I'll pray on it. And again Georgia your kind words helped to ease the sting of this new today. Gratefully, marg Hello Sooverit. I am really sorry that you were denied coverage. That sucks, especially since you have put a 1&1/2 years into this. Is the Lap Band out of picture for you now, or is there any way you can go the route of self pay or get a loan? Sorry this happened to you and I wish you the best! PS, I am sorry about your sister. I hope and pray you can find a way to make this happen. Today 09:41 AM

<TABLE cellSpacing=0 cellPadding=0 width="100%" align=center border=0><TBODY><TR><TD vAlign=top> <TABLE cellSpacing=0 cellPadding=0 width="100%" align=center border=0><TBODY><TR><TD vAlign=top> <TABLE class=tborder id=post808534 cellSpacing=0 cellPadding=6 width="100%" align=center border=0><TBODY><TR vAlign=top><TD class=alt1 id=td_post_808534 style="BORDER-RIGHT: #d9d9d9 1px solid">Believe it or not I rushed into this <HR style="COLOR: #d9d9d9; BACKGROUND-COLOR: #d9d9d9" SIZE=1>It's taken me almost a year and a half of work but it's over at least. This...meaning insurance approval with Cigna. I was Denied because I was shy a 40 BMI by 10 -12 pounds when I submitted everything they were looking for I jumped thru every hoop and paid out every last cent to docs. etc. but I should have know (and not listen to people on this site that said Cigna does cover with no co mobidities - NOT TRUE) they clearly state that they do not cover those under a 40 BMI unless you have grave illness that don't respond to meds.. Not only that but they will not approve any claim even related to this one in the future. Meaning if I gain 10 pounds in the next year.even if I maintain that for a year and..easy to do at my age...they won't even consider it. My fear is of dying of a heart attack like my twin sister did of obesity last year. My chest is so huge it strangles me at night and causes sleep apnea that doesn't appear on the "test" ...another few hundred bucks there. My warning to those seeking insurance approval with CIGNA....if you're not starting out with a 40 BMI save your money until you are or get a loan unless you can clearly prove a comobidity. __________________ financing </TD></TR></TBODY></TABLE></TD></TR></TBODY></TABLE></TD></TR></TBODY></TABLE><TABLE class=tcat style="MARGIN-TOP: 3px" cellSpacing=0 cellPadding=0 width="100%" align=center border=0><TBODY><TR><TD vAlign=center width=7></TD><TD class=tcat vAlign=center width="100%">food and Nutrition</OPTION> <OPTION class=fjdpth2 value=82> Cooking, Baking and Recipes</OPTION> <OPTION class=fjdpth1 value=81> Fitness & Exercise</OPTION> <OPTION class=fjdpth1 value=11> Doctors and Hospitals</OPTION> <OPTION class=fjdpth1 value=20> Fill Doctors</OPTION> <OPTION class=fjsel value=8 selected> Insurance & Financing</OPTION> <OPTION class=fjdpth1 value=12> Cosmetic and Reconstructive Surgery</OPTION> <OPTION class=fjdpth0 value=122>Lap Band Support Groups</OPTION> <OPTION class=fjdpth1 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I was in a VERY gray area....I had to know if what where happening (being approved) would happen to me. Just giving a warning for others to not go through all this with Cigna Point of Service.:confused2:

If any of you are fighting a denial I cant stress to you how important it could be for you to contact ObesityLaw.com, I would never have been approved without thier help. Janine Congratulations Janine...it's always good to hear a story like this! Good for you for not giving up! May I ask you for some help. I am just so tired of spending 1000s of dollors on this whole process and countless hours of my time just to be rejected. I am afraid to lay out any more money on this. Could you please help me with the following questions. I would be most grateful. ` What was your BMI? ` Did you have co mobidities? ` How much did the attorney's charge you each time? ` I was rejected due to a BMI not being 40 for a year or more. It was a 38 at the time. If my BMI is 40 NOW (which it just became) and I start the process all over again will my visits to the Phych, Nutritionist, Surgen still be good after over a year? They told me I had to have a BMI of 40 for a year and they didn't approve my non life threatening comobidities due to meds help. Well I can start the clock now but go through all that again!!?? I guess I'm wondering at what point is it worth fighting them. Should a wait a year or two where I will totally be a 40BMI with some co morbidities for them too. Will they reject me because I tried to apply before?

I faxed my paperwork to the surgeon's office on February 11th (paid 23 bucks to do it by UPS) and got a letter from Cigna saying they received my paperwork on March 28! A week later they denied my claim.

Just looked on the appeal site that was posted by someone here and I change my mind I CAN NOT throw any more money away on this...! I will not appeal....thinking of perhaps changing to Aetna if possible and starting the procees all over again now at a BMI of 40 - not that that's not gonna cost me too.... Any opinions?

Well...it took 6 weeks supposedly for CIGNA to receive my paperwork from my surgeon's office then it took Cigna 2 weeks to turn down my claim because my BMI was not 40 for a year. I plan to appeal and then start this up again as I am a 40 BMI now. I may change surgeon's as well to a local doc Dr. Geiss on Long Island. Yes it cost me a small fourtune to go through all this but I can write a book about the whole proceedure now....good to see the positive. Marg Oh and it took a year for my PCP to get the 6 month diet paperwork correct! :thumbs_up:

My surgeon's office sent in my paperwork over 5 weeks ago and they have not heard from Cigna either way. I am hoping that this is a good sign? I heard that approvals take longer than denials? Does anyone know what an average waiting time is for approval from Cigna is? Any feedback would be appreciated. This journey is getting old...I've been working on this for over a year now!! Thanks, Marg

Hi guys ...I have Cigna point of service plan or PPO (forget what this stands for). When I called last week CIGNA said they were waiting on verbal authorization from my PCP. Which could take a whlie with the crazy secretary there who has been the only one throwing wrenches into my year long plan here. Not sure why...unless her ins. doesn't cover lap band and she's sore. The guy on the phone said you haven't been declined they just need more clincial info. I am almost feeling excited here. ....will let you know tho.:biggrin:

Finally today a letter from CIGNA saying ..."We received a resquest from you on 3/25/08 (faxed my paperwork _$30.00 UPS store on February 20th to the Sugeon's office! - trusted the coordinator there- silly me) and they said To process your request, we need the following additional information: - Clinical information for medical necesity is needed fax info to 132438948923 I sent them EVERYTHING they asked for!!? Has anyone ever received this? They are closed today of course ...what is clinical info exactly? :thumbup:

Hey Susie: Thank you so much for taking the time out to share your words of wisdom. You gave me strength to put up a fight for my insurance rights! I am very similar to you ...same BMI and age! Though I haven't weighed myself in months I could be higher by now. I have sent in my very lengthy physcian's approval on his letterhead and all the rest exactely the way they want it. So how are you doing now? Have you been banded yet? How have you been doing feeling? Thanks again, YOurs, Marg