noonie

Yes. Severe gas and bloating and sharp stabbing upper gi pain. Resolved after taking pantoprazol daily with carafate.

yes, apnea, diabetes, hypertension, etc. are comorbidities. You shouldn't need then with a BMI > 40.

The request/file went in on 1/14 and I was approved 1/22. My BMI is < 40 with comorbids. It sat on the screening nurse's desk for 1 week before being sent to physician review.The BCBS physician approved it almost as soon as they got it. This is BCBS federal. ( FEPblue)

So we kicked NALC to the curb and signed up with BCBS Federal during open season. BCBS took effect 1/13, and my surgeon's office faxed over my file/request on 1/14. I got approval on 1/22 and surgery is 1/29!!!! Anyone reading this who has NALC and BMI < 40.... if you are stuck with them, appeal, appeal appeal! If it's open season, bail to another company in the FEHB program!

I'm working on getting a sleep study.. my primary offered to order one back in Sept. My new insurance takes effect Jan 13. I have decided though, to switch to RNY bypass because of my sweet tooth (yay dumping syndrome) and the fact I already have a problem with acid indigestion. Also, my insulin resistance could be better served by RNY. I figure this is a one shot deal.

@barbi, NALC is underwritten by Cigna. My information hasn't even made it to Cigna because it was NALC, not Cigna, that shot it down. NALC explains that they only forward cases to Cigna once it passes their own internal precertification.. so in essence, the federal postal unions play the middleman. Cigna policy 0051 clearly states my comorbidities qualify. NALC reports they don't recognize and don't have to recognize those. NALC apparently only recognizes immediate life-threatening comorbidities such as "severe diabetes" or "severe cariopulmonary disease." Apparently they believe there is such a thing as "mild diabetes." So I guess unless one has had a heart attack or had limbs amputated, one will have to sue NALC/OPM to even get their paperwork through them to Cigna.

ok.. so I am angry.. but they actually claim they reject me because 1. I dipped below 35 BMI in January 2012 because I was doing their mandated weight loss program and 2. I am on bp medicine. NEVER mind the BP medicine can't lower my bp below 140/90.. Cigna's threshold. and also they consider snoring not apnea.. and ignored a whole host of comorbidities including knee problems, fatty liver, and ateriovenous malformation in the brain that can't handle elevated cranial hypertension. .. oh, and arrythmia treated partially with ablation.

well, keep in mind thomasplt that NALC is NOT Cigna, but a union run insurance underwritten by Cigna.. Cigna has policy 0051 that is pretty liberal compared to NALC who adds criteria. I hope those Federal employees read my post and opted out of NALC... let them die the natural death they so well deserve. I am going to appeal.. their second rejection letter rejects pretty much anything that CIGNA recognizes as a comorbidity. Use the words "arbitrary and capricious" in your appeal letter, because that legalese will carry forward. NALC is poised to reject everyone because let's face it.. the postal service is in dire straits. Their union is worthless.. and any union that would tighten criteria is NOT worthy of dues.. (POSTAL EMPLOYEES>> TAKE NOTE) Too bad the cowards don't put a name to the denial letters because I want names for my attorney to individually sue. I am a union representative of another agency..but I would implore NALC members to FLEE from these crooks and defect to another postal employee union.

Keep in mind, anyone reading this, that NALC is an additional layer of bureaucracy on top of the cigna policy #0051. I found out from NALC that, according to them, they can do what they want, and what they choose to do is IGNORE evidence of universally-accepted co-morbidities, including ones recognized by their underwriter, Cigna (hypertension of over 140/90 despite medication--with letters from 2 primary care physicians spanning a period of 6 years). Yes, you can waste months on appealing and ultimately suing OPM (which you will win, if it's a case of "arbitrary and capricious denial".. see case Dunn vs. OPM re: NALC denial of surgery). But since open season goes until Dec. 10, I recommend anyone trying to get approved via NALC jump ship to a plan that specifically recognizes co morbidities and doesn't add words like "serious" and other limiters. Oh I am certainly encouraging those who do change, to still appeal in the meantime.

Congrats! My insurance quickly denied mine even though they knew my surgeon's office was gathering and sending in the information they wanted. Now it is just a matter of them evaluating the new information they requested. I meet all the criteria but am just over 35 bmi, with well documented comorbidities. I am confident that what was sent was enough. It certainly is to win a lawsuit.

@kbby, I called the NALC number at the top of any EOB and pressed option 4 to speak to a claims representative. They showed that they received the package from the surgeon today and it was forwarded to their medical review department. If they are telling you they haven't received it, have your surgeon's office follow up or resend. In my case, they even read back the requested procedure, so I know I wasn't just getting a canned answer.

I called NALC and they said the letter from the surgeon came today and it was sent down to the review department. They said from here it can take up to 30 days.

I have NALC/Cigna.... I have heard nothing yet... it went in last week. I am worried because my BMI is borderline at 35.9 with high blood pressure despite medication. I dipped below 35 once in the last year when on the dr. supervised diet, but the HCG stopped working (developed a tolerance to the hormone) and I gained it all back, especially after my gall bladder removal.