innerme

Good luck! They told me the first time I talked that they tell people up to 30 days but they usually have a decision in 8-10 days.

Typically you wd pay your copays up front. As far as the remaining estimated due to the hospital and doctor that wd be up to them if they bill or require before surgery. I have to pay my copays and the Estimated due amt to the surgeon prior to my surgery, the remaining hospital, anesthesia, etc will be billed to m after the surgery.

I have a FSA and have been using one for several years. Yes you can pay any copays, deductibles, and for prescriptions using this. The great thing about a FSA once you determine what Amount you want extracted yearly the amount becomes immediately available to use even though it will take the complete year to withdrawal from your paychecks and it is tax free. As far as 5 year weight history- any medical documentation showing your weight regardless what doctor it comes from is sufficient. I had documentation from several sources which included a orthopedic doctor, my primary physician, a emergency outpatient facility. You can request your records from any of your sources and just ask fir last 5 years and they usually provide at no charge. I have even seen some post that people who had not been to a dr for 5 years were able to supply pictures of themselves that were date stamped to provide as a history. Hope this info helps.

I have Cigna- I met every written qualification - they were extremely anal w the paperwork. My drs office literally sent the copies of each mths checkups and they gave a denial within 5 days saying they wd like my physician to extract particular pieces of info and combine on a form. They then asked for a second peer to peer to determine medical necessity. I truly believe their mission is to wear us down. Only the strong will survive.

I started in Nov. Completed my 6 mth supervised diet April 4th and paperwork was submitted a week later to Cigna. Still waiting on approval. They were real fast with rejection, sd needed 6th mth visits submitted on seperate paperwork by itself instead of each months doctors visit notes. They had a peer to peer meeting with my surgeon and as of yesterday they still had nothing from Cigna. My Doctors office is hoping to have decision from insurance by Friday. Hopefully you'll have a better experience than what I have been having.

I have spent the last 7 mths jumping thru the insurance hoops making sure every little detail was taken care of and not leaving anything to chance when it comes to 6 mth diet, test, psych eval, 5 years of medical history not just 2 and every other detail the insurance requires. I fit the requirements of my insurance requirements for my bmi having type II diabetes, gerd, high cholesterol, having issues with my joints due to my weight to the point I have had to have foot surgery, etc....My surgeons office submitted the paperwork and Cigna sent a denial as they sd it was missing 2 pieces of information, which by the way was submitted. My surgeons office immediately following protocol scheduled a face to face with Cigna. My case worker stated to me the denial happens alot more than not and they know that more than the required information was submitted. Last Thursday my surgeon and case worker had a face to face meeting with Cigna as they were being told they needed 2 more things for the approval 1) a statement saying I was cleared for the surgery from my primary physician even though my physician had put in a referral as well already wrote a long letter explaining the benefits this surgery wd have on me, and 2) they preferred not seeing each months doctors notes from the file for my 6 mth diet/exercise program they wanted it submitted on a seperate form -REALLY? My Case worker told me it was the first time they experienced this and was blown away because they knew everything was sitting there in black and white. Ok so my doctor takes care of these two pieces of information and my surgeons office submits it. So today I called Cigna to see if they have received the information and if they have reviewed it yet and they come back and say they have requested a face to face meeting with my primary physician to discuss medical necessity! Has anyone ever heard of this, or has this happened to you? What was the outcome? I'm getting extremly annoyed at this point!

I am in Florida. I called Cigna again yesterday and spk to someone else and they sd it's not a face to face meeting they need a Peer to peer meeting. I spk with my coordinator again and she sd she is totally blown away with this but they are checking with Cigna again. She shared with me that one of the patients had did a 6 mth diet thru weight watchers which was clearly stated as a acceptable diet but when the paperwork was submitted the insurance came back that they werent going to accept weight watchers and she needed to do another 6 months. I think insurance companies are trying to find more ways to reject people since more people are deciding to go this route. I'm just biding my time now and waiting to see what happens.

No need to be nervous. I remember being rolled into the room and them working around me a few minutes and the anesthesiologist asking me a couple of questions and don't even remember closing my eyes. next thing I remember is waking up in the recovery room w the doctor talking to me.

Unfortunately I still don't have good news to report! I am so aggravated- I controlled myself and waited to contact Cigna to see if they had finished their review and they told me that my surgery has been denied because they haven't recvd the paperwork showing I have had 6 months of a physician supervised diet nor did they recv a letter of neccessity from a dr other than the surgeon. WTH! What in the world is my case worker even doing? I have tried getting a hold of her since Friday, left a message a few times and she hasnt even called me back? I'm so infuriated, after all the work I've done to get to this point and due to the incompetence of my case worker I'm sitting here on pins and needles just waiting. I tend to be a perfectionist in alot of matters and I have a complete intolerance to people who don't do what they are supposed to do. I wanted know complications with the paperwork so I reviewed Cigna's requirements numerous times to make sure that I completed every single thing that is required and because the case worker did not send it I'm sitting here with another 2 weeks wasted waiting! Does any one know If I can send documentation directly to the insurance company or am I totally dependent upon my surgeons office making sure they get everything sent in?

My surgeon's office set up my appt with the Nutrition. The nutrition I saw was very familiar with the surgery and what the Dr expects after the surgery. The nutritionist only had to send a letter to the surgeons office to let them know that I had completed my nutrition class.

This blog is being created to keep me stay focused on my goal and have accountability as well as hopefully be a resource for others who are considering starting their own journey. My journey started a few years ago when I started researching Weight Loss Surgery (WLS). I went to my very 1st seminar and found it quite informative. Until my husband went to the seminar he was not very thrilled about what I was considering and after that I have really have had his support. At that time most insurance companies were still not covering the Sleeve (VSG) and I myself had never heard of it but found myself quite intrigued with the information. At that time I was considering the lap band procedure. After the meeting I was ready to make my change but got really discouraged when the group that the Dr uses to handle all the insurance and scheduling, etc seemed to be more about themselves and the money they could make than what was good for the patient. Since I got the huge vibe that they were all about the money I decided to call my insurance company to see if there were other options and explained how this group wanted to charge for everything and it was all out of pocket and they sd it wasnt covered by insurance. My insurance encouraged me to find another doctor. I decided to do more research and decided surely I can do this on my own, yea right! So here I am 3 years later. I made my decision to go ahead and have WLS in October 2011 when my lab test came back to the dr showing that I was no longer a borderline diabetic that I now have type II diabetes and knowing my family history I knew this wasn't something to play around with. My doctor asked if I had ever considered WLS as if it was his idea, lol, and I told him I had and he wrote up a referral for me and it was ready for pick up in just a couple of days. So here's my calendar of events so far: October 25 - had annual physical and blood test done Nov 1- Drs appt - got results from test and Dr sd wd give referrel for WLS Nov 10- Bariatric Seminar Nov 11- Drs appt regarding blood sugar levels Dec 12- Drs appt Jan 12- Drs Appt ( gotta make sure I see doctor for 6 consecutive visits to keep insurance from denying surgery) Jan 12- 1st visit with surgeon Jan 17- Psych eval- was told eval wd be sent over by next day to surgeon with approval Jan 25- Upper GI and lab work done Feb 3- 5 mth visit with Primary doctor Once my 1st visit with the surgeon was done, I have felt as if I had been on a rollercoaster of dr's appts but I totally don't mind at all! My Dr appt with my surgeon went very well. One of the requirements they have is you must bring a support person with you to your 1st appt. They don't care whom you choose as long as the person is 18 or over. My surgeon told me the sleeve was a excellent choice and provided my husband and I with very informative information of what to expect in the coming weeks as well as when I have the surgery and my hospital stay. He also encouraged for me to go ahead and get plugged into their support group that they have which I find is a very good idea. I could use all the support I can get. One of the things that made me feel so much better about this is the whole process is totally different then the process I started going on 3 years ago. This is being handled as any medical need where everything can be filtered thru my insurance instead of made to feel as if this is elective surgery therefore if you want a support group you have to pay for it out of pocket, if you want insurance filed you have to pay for it out of pocket. I am so glad my Dr referred me to such a fantastic group. I have done my research and the Dr's are excellent and have had no deaths from the result of their surgery. In fact I didn't find not one negative thing about the entire group. One thing I do want to say is that the surgeons office gave me a list of Psychologist that I could use if I chose too to schedule my Psych eval. I actually called and spoke to one of the staff at one of the offices and I could not believe the fees, besides the 20% copay they sd they charged $185 to actually send the eval to the surgeons office and insurance did not cover that she did a quick calculation and sd it looked as if I wd be paying somewhere around $400 for my 1st appt with filing fees included. I decided before scheduling I should call my insurance company (Cigna open access) and I'm so glad I did. I called my insurance and they sd my employer actually has a EPT plan with the insurance and they gave me a list of names and numbers along with getting a EPT # for me and told me I could have up to 3 visits free and there wd be no cost for the evaluation that insurance wd take care of any cost. They also informed me if I needed any additonal visits after my surgery or even before that the visits are only $10 a visit. WOW! If I had not called my insurance I wd have paid out quite a bit of unnecessary money and I don't know about everyone else but I work hard for my money and have no desire to throw it away unnecessarily. I decided to go ahead and start working on trying to lose weight before my surgery and start walking to work on my endurance so once I have the surgery it won't be as difficult. I already know that alot of people are going to ask why have the surgery if you can lose weight on your own, the problem is i have never in 20 years been able to get below 201 lbs and the last few years with the pre diabetic sugar highs and now full blown diabetes it is even harder to lose weight. WLS is not a quick fix but it is a tool to help people get the help they need. I'm looking forward to my journey towards good health and am very open to words of wisdom and encouragement. Tammy

I just had my 1st appt with Dr Hodgett who is with the Bariatric group at Baptist Hospital, downtown Jacksonville, Fl. I started looking for a surgeon a couple of years ago and looking at my options and wasnt even aware that there was a Bariatric group at Baptist until my Primary recommended the surgeons there. I went to the seminar at Memorial a year ago and was so disgusted by the fact that they had a outside agency (Novus) who you had to go thru and pay before you cld even make a appt with the Dr.and they even told me if my insurance was denied I wd lose my money. I went to my 1st seminar at Baptist in November and was very impressed with the Drs and all the research I have done shows they are excellent doctors. They also have never lost a patient. In the seminar they express to you that they will handle take care of all your filing and they provide support before and after surgery at no additional charge. Hope this info helps.