northmsgirl

Lawyer? Ha! Lawyers of past acquaintance suggested I pursue the field, but it didn't call to me. How could I have known I was preaching to the preacher? By training and probably by inclination, you're given to notes, mental or otherwise, and the prep work before advancing into the fire. As one who's worked with and marveled at humans in many settings, I can say with assurance that a great many would not do the basic research for themselves. I do wish you well. If my plan had required supervised, pre-op weight-loss, I'd be happy to relate what I could. I hope you'll return with the outcome of your situation. It will be interesting to know if you were able to move the immovable and, if so, other readers would be helped. I love lawyering. It's fun, and is perfect for me. It's all in framing the issue. You have to give the decision maker the impression that you are on the side of goodness and right, and then give them the written authority to hang their hat on. If my program had been 89 days, it wouldn't have been acceptable. If I had gone to the dr on September 29 and October 20, it would not have been unacceptable. Even October 26 wouldn't have given me 90 days. It does not reason that 95 or 97 days is unacceptable, that October 29 or 30 were the only days I could go for my last visit, or that I could basically punished/denied for beginning this process at the tail end of a calendar month. I did not "skip a month." I know their job is to basically deny everything, but it's my job to back them in a corner with their own documents to where they can't! I'll let everyone know how it goes. Thanks for the well wishes! Sorry if I've been edgy. I've been dealing with my insurance company on an unrelated issue and with other medical companies on assembling my records from 3 states and 3.5 years away. It sucks.

G.

I'm a lawyer. I document and read carefully by nature and training. Didn't mean to snap, but I was on edge last night anyway, and I just thought it was a little rude to not answer the question I was asking but instead tell me to read the lit. I didn't feel the need to preface my question with "I've already read the documents," because honestly I would assume most people would have already done that before asking a question about requirements. Frankly, the answer to every single question in this forum is read the lit and talk to your insurance company. I was just looking to hear others' experiences/insight regarding the diet requirements. Thanks for being willing to help. I do appreciate it.

Thanks!

Federal employee. Thank you!

Surgeon's office is checking and going to try to make it work!!

I have Cigna and the requirement is a 90 supervised nutrition program. It is 90 consecutive days or 3 consecutive months. You missed October so it's not consecutive. So sorry this happened to you. Personally, I CMA by doing 4 months, July, August, September and October to ensure there were no surprises. HTH So, you think that I could only have gone on October 30 to meet requirement? But if I had gone September 3 I could have gone October 30? That just makes zero sense. It's only been like 96 days since my first appointment. And I've read that the visits have to be 30 days apart (like you can't go September 20 and October 3). I don't feel like I should be punished because my appointments were at the very end of a calendar month. I didn't skip a month. I'm going to call them today and I'll update with what they say. Thanks for your insight, even if it was disappointing!

Not an idiot. First thing I did when I started considering the surgery was read my insurance's literature, which I did again yesterday (both the brochure and coverage policies). They are, in my opinion, ambiguous and don't cover this exact situation. Also, my insurance company is closed right now, so I thought I could get some help in the meantime. So, yes, actually, insight is exactly what I need. If you don't have anything to offer, please don't feel like you have to respond. Thanks.

For the sleeve? Hopefully with no diet requirements? I may have messed up my Cigna diet (see other post) and open season is soon for January (in case I need to switch)? Thanks!

I thought my last visit was tomorrow, but am now devastated because my surgeons office is telling me I have to start over because I "skipped" October. I went July 27, August 27, September 29, and have an appt for November 3. I could not go on Friday, October 30 which was the only business day that would have given me 30 days between visits but still have he last visit in October. Any insight as to whether the surgeons office is correct and the 11/3 date is too late?? Thank you!

It should be listed in the plan brochure. Mine is $350. Nm M

Hi, everyone. I'm expecting to get sleeved next month, and I know that after I lose my weight I will def need plastic surgery. I'm also a federal employee. Have any of you had federal health insurance cover any procedures? Deny them? Basically, if love to hear about your insurance experiences. It's almost open season. thank you!

My twin sister had the RNY at 19 years old (17 years ago- when it was an open surgery). She is glad she did it, but wishes she would have sought out some help dealing with the mental and emotional issues she had related to the surgery and losing weight. The difference in how she was treated by people when she was obese vs thin made her very, very angry. If you have other mental health issues make sure you have them under control and be proactive. She was not proactive and has had a hard time occasionally, not because of the surgery or weight loss, but probably exacerbated by it. I wish I would have done this surgery 10 years ago, though. . Good luck.

My BMI is 53. I am 36 with no comorbidities or other health problems. My surgeon said he would so the sleeve or the bypass, whichever I was more comfortable with. I have selected the sleeve. It is less invasive, and there are lower rates of complications. My twin sister had the bypass (open! 14" incision!) 17 years ago and said she would do it again tomorrow. Surgeon said stats show that patients lose and keep off more of their excess weight with the bypass, but he has plenty who have lost all of their excess weight with the sleeve. I think its just a little harder, since it's only restrictive and not restrictive AND malabsorbtive. He said the only time he really strongly recommends the bypass is for a high-BMI patient who also has diabetes. Apparently the studies show much better cute rates for diabetes with the bypass. I also want to get pregnant (I have a 3 year old). My OB said I could probably start trying 6 months after surgery. Apparently the risk is to mom, not so much baby. I lost 65 pounds in the last 7 months of my pregnancy with my daughter - I can't imagine I'll be eating less after surgery than I did with her. I was realllllly sick.

Was your weight still lower than when you started your program? My surgeons office is the one that told me no net gain for Cigna. Maybe it's not a hard and fast rule.