cathychatts

I am having problems getting approved. I was denied on April 16 because they needed a letter of medical necessity. A rep from Cigna indicated that was all they needed. I pray that I can get an appeal going quickly. I hate this waiting game!

I don't think my Doctor is going to use the "no-port-band" I suppose it is the new APS band. I sounds like it has been out about a year now, and the clerk at the office said this would not be available until May. Is their a new version of the band just becoming available?

My doc's office said, as of the 1st of May they will be using a new type of band that is new and improved. I found something about one of them going all the way around and one that was wider and had less chance of slippage. I am getting impatient and the office assistant said it was good that I had to wait because of this improved band. I suppose it is right, there is good in everything... even waiting!

I just called Cigna and was told that my claim was pending. The rep said she was surprised because it usually took longer. My information was faxed on the 10th of April and received on the 12th by them. She said it was very quick that the case was pending. The insurance clerk at the doctor's office faxed over 100 pages. It is looking good! :thumbup:

The Insurance clerk at my doc's office called today and said Cigna had denied me because of the 6 months. I have been in 2 different programs, but neither consecutive, but they did overlap and go 6 months... anyway, :huh2:someone from Cigna called the doc's office and asked for my home phone number and said she knew what they were looking for and wanted to give me advice... she also has had weight loss surgery. So the insurance clerk got together the records according to what she was told and faxed them today. So, I really don't know where I stand right now. :biggrin: Another interesting thing the doc's office told me was that beginning May 1 they are going to begin using a new type of band. I don't know anything about the type of bands. :rolleyes2: Good Luck to you! And thanks for the support and encouragement!:tongue:

I just called Cigna, my paperwork (100 pages) faxed on the 10th, received by them on the 12th, and the rep said it is pending already! :biggrin2: She said that is very quick, that she was surprised that it was moving so quickly! Yea!!!!:thumbup: Wish me luck! :thumbup:

I just called Cigna, my paperwork (100 pages) faxed on the 10th, received by them on the 12th, and the rep said it is pending already! :biggrin2: She said that is very quick, that she was surprised that it was moving so quickly! Yea!!!!:thumbup: Wish me luck! :thumbup:

The Insurance clerk at the surgeon’s office just called and said she faxed over 100 pages to Cigna on Thursday. One step closer to being banded! Yeah!!!!! I am so excited. :smile2:

I just called Cigna and they have not even received the paperwork from my Surgeon's office. The clerk has not even sent it yet. That really bums me out! :frown:

Hi Carrie: I also have Cigna through the State of Tennesse. You can go to the web site for Cigna and find information concerning the surgery going to this link http://www.cigna.com/customer_care/healthcare_professional/coverage_positions/medical/mm_0051_coveragepositioncriteria_bariatric_surgery.pdf or just call the phone number on the back of your card. I have called several times. I had a little difficulty getting them to pay for the phyc evaluation, but I did succeed after a few trys. That is covered by Cigna, not the Megellan, because it is a requirement for the surgery. Your mental health carrier will deny it. There was no "in network" provider available so they arranged it with the Doctor of my choice. They will also pay for the nutrionist and the 6 month diet plan also. You just have to be sure the provider codes everything correctly. Be sure to call Cigna yourself, it makes it much easier to get things moving. I have completed all the necessary visit, test, paperwork and now just waiting for the surgeon's office to submit. I even called Cigna to see if the paperwork had arrived and they happily checked for me. The main thing to remember is to be nice :mellow:when asking and they will bend over backwards to help. It is hard to be sweet sometimes when we are so aggitated, but it does work. Good luck! :ohmy:

My surgeon's office is going to submit my paperwork today. I hope I don't encounter too many problems. I fought with them over my phyc evaluation and they finally got it approved... and then they didn't pay. Their communication sucks.:biggrin:

Hello Everyone: I finally have the entire process completed to have my paperwork submitted to my insurance. I dropped off the final charts from a Weight loss clinic yesterday. :biggrin2: If the paperwork is any indication of your desire, we all certainly have learned to conform! I will anxiously await word from Cigna if I have completed the 6 months required diet. Thanks for all your support, I enjoy reading the post here, you are quite good at support and motivation! :w00t: I hope I can be a support to someone in the future. Thanks! BYW... I live in North East Tennessee - the Tri-Cities area.:biggrin:

Hello Everyone: I have been reading post for awhile and now getting active. I just figured out the ticker and ready to get on with the journey. I apperciate all those who have experienced what is in store for me. I look forward to and appreciate all your help and advice. I am a 59 year old Vocational College Instructor and have had a weight problem most of my life. Now, it is getting worse and my health is showing the consequences. I have been to the inital consultation with the surgeon, Dr. Kappa, in Kingsport, Tn and am now in the process of getting the necessary documents, tests, and consults. I have Cigna insurance. Any advice and encouragement will be greatly appreciated!

I am so looking forward to this surgery and so ready to get rid of the weight. I actually gained 15 lbs to get my BMI over 40 for Insurance... I am kinda ashamed of that :thumbup: but it serves me right, now I can't take the weight off. :w00t: I hope to get my approval soon and may have to do the extra 6 months. I hope I don't but if I do... anyway. Good luck to those of you who are being banded soon. And Indio girl, you are quiet an instiration. I hope i do half as good as you, I am tring to get thing together so I will be ready and as soon as I get the ok from the nurse I hope to begin a pre-op diet. I notice that many loose significaitly before surgery. i will gladly diet if I know I won't gain it back so easily. My body resist loosing any of itself. I think my fat cells have minds of their own:confused2: I am so hopeful now after reading the post here and getting all the good advice and suggestions. I thank all of you!

This tread looks very interesting... I can't wait to get off work tonight and read it!

I hope everyone had a nice Easter. I am making progress toward being banded. I hope to have everything ready for insurance on Wed. I will have the gallbaldder then. I have done both of the informational meetings, the one-one-one nutritionist session, phycological evaluation, sleep evaluation, group support meeting, pap, mamogram, I have completed 5 months in a doctor supervised program and 3 months with my general doc when she gave me phentramine. I pray that is enough! I have a BMI of 41 and have sleep apnea, osteoarthitis in the knees, gerd and asthma. Surely I will get approved! I finally toldy my Boyfriend about this and I was shocked that he was so supportive. I expceted him to be a problem. His only concern was he wants to loose weight too. I told him I was afraid to tell him in case he only liked "fat girls" Silly me. :wub: Maybe I have found a good one for a change. Have any of you seen the programs on The TLC channel with Paul McKenna? I am going to give the things he talked about a try. It seems like it can go hand in Hand with the band.

I hope to have everything ready for insurance on Wed. I will have the gallbaldder then. I have done all the information meetings, nutritionist, phyc eval., sleep evaluation, group meeting, pap, mamogram, I have 5 months in a doctor supervised program and 3 months with my general doc when she gave me phentramine. I pray that is enough!:tt1: I have a BMI of 41 and have sleep apnea, osteoarthitis in the knees, gerd and asthma. Surely I will get approved! Good luck to you, I am always happy to see someone approved. I finally toldy my Boyfriend about this and I was shocked that he was so supportive. I expceted him to be a problem.:wub: His only concern was he wants to loose weight too.:thumbup: I told him I was afraid to tell him in case he only liked "fat girls" :wub: Silly me. :crying:

I have been stressing over the 6 month weight loss program requirement from my insurance and found this explination on the Cigna website. It does make it a little easier to consider why they require it. :biggrin: But I still hope I have already met the requirement! Here is the reference: http://www.cigna.com/customer_care/healthcare_professional/coverage_positions/medical/mm_0051_coveragepositioncriteria_bariatric_surgery.pdf The benefits of a preoperative weight-loss program include all of the following: • identification of those individuals who will be committed to and compliant with the short-term, long-term and lifelong medical management follow-up, behavioral changes, lifestyle changes, and diet and physical exercise regimen required to ensure the long-term success of this surgery • reduction of operative morbidity and surgical risk • improvement in surgical access with weight loss • reduction of the severity of obesity-associated risk factors, such as blood pressure, glucose intolerance, cardiorespiratory function and pulmonary function Access to a multidisciplinary team approach, involving a physician with a special interest in obesity; a dietitian or nutritionist; a psychologist, psychiatrist or licensed mental health care provider interested in behavior modification and eating disorders; and a surgeon with extensive experience in bariatric procedures, is optimal. Realistic expectations about the degree of weight loss, the compromises required by the patient and the positive effect on associated weight-related comorbidities and quality of life should be discussed and contrasted with the potential morbidity and operative mortality of bariatric surgery. With current state-of-the-art bariatric surgery procedures, patients lose an average of 50–60% of excess body weight and have a decrease in BMI of about 10kg/m2 during the first 12–24 postoperative months. Most long-term studies show a tendency for a modest weight gain (5–7 kg) after the initial postoperative years; long-term maintenance of an overall mean weight loss of about 50% of excess body weight can be expected

Today is my one-0n-one visit with the nutritionist, :unsure:and I have done all my homework. The only thing left on my list is the gallbladder scan and that is scheduled next Wednesday morning at 7am.:thumbup: Then the surgeon's office manager will submit to my insurance. I hope and pray that they will approve it on first try! I will certainly let you know, in the mean time I have been trying some of the protein powders and so far I love cholclate Muscle milk:drool5:. I am going to try to find a place to see if I can get assortment packs. I don't know about GNC they may have a trial pack of stuff. I am working today and the students are busy working so I can surf the net a little today:biggrin: Happy Easter to you all and good luck!:Dancing_shocked:

Roxy, From all I have read and gotten from talking to some reps from the Doc and the Insurance also, they want you to loose weight during the 6 month program, even if it puts you below the BMI, but I am going to try to get that in writing! I am on the edge of 40 and that was stooping to be 5'1" and wore heavy clothes and kept my heavy shoes on....

Mary, I don't know what they mean exactly, but I think they are talking about the most desirable support group. They refer to a mental health provider interested in "behavior intervention" and eating disorders, to me that sounds like group therapy. Funny, that is what they say is optimal, but they won't pay for that, only the evalulation. If you have what they are referring to you would have to go to the mental health provider. For me that is Megellan, not Cigna. Who really knows? I think that if they won't accept what i have already done, then my sugeon's office has a program that they do to get that requirement. I hope so anyway. Let me know what you find out. I am going to a group support meeting tonight and I hope to get more information there.

I have been sitting here reading this thread all evening. I am an instructor and have a night class in right now, they are busy working so I can read! (Great JOB!) And I love you Guys! I have learned so much and I have been so inspired by your post! I am working on the requirements to be banded and will be ready to submit to the insurance (Cigna) next week. I have seen the surgeon and he says I will be a perfect candiate for the band. My biggest problem right now not dieting ! Who would have ever thought?!!! I want to get started, but the NP and the Nutritionist said not to diet until the first attempt at insurance. So, I will be compliant and keep on eating myself to death! :biggrin: --- Not really, since I made the decision to get banded, a strange thing has happened, My motivation is stronger, I am ready to get going! Thank all of you for the posts! All information is very welcome!:thumbup:

Roxy, I have Cigna and I am working on the requirement for surgery. I spoke with the insurance company rep and here is what they told me, I have copied and pasted directly from the Cigna website. I am hoping that I have met the requirements, but not certain. I may have to begin the 6 months again, I figure if I will I will just work on it, they say the 6 months is to show that you have the desire to live the life-style required after banding, they say that the band is only a tool that will help you complete your weight loss and keep it off, that the real work is what you do. The band is not a "magic bullet" I think they are right on with that, after reading most all the post on here, I think the successful ones are the ones that really work hard at the lifestyle changes. I hope you are successful and I also hope that for myself. Keep in touch and let me know how things go! Seems we have a lot in common! Cathychatts! (BE SURE TO READ THE FOLLOWING) The Following came directly from the Cigna Website: CIGNA HealthCare covers bariatric surgery using a covered procedure outlined below as medically necessary when ALL of the following criteria are met: • The individual is ≥ 18 years of age or has reached full expected skeletal growth AND has evidence of one of the following: BMI (Body Mass Index) ≥ 40 for at least the previous 12 months. BMI (Body Mass Index) 35–39.9 for at least the previous 12 months with at least one clinically significant comorbidity, such as a serious cardiopulmonary problem, Type 2 diabetes, hypertension, coronary artery disease, or pulmonary hypertension that has failed to respond adequately to appropriate medical management. • Active participation within the last two years in one physician-directed weight-management program for a minimum of six months without significant gaps. The weight-management program must include monthly documentation of ALL of the following components: Page 2 of 28 Coverage Position Number: 0051 Vital signs, including weight Current dietary program Physical activity (i.e., exercise program) Behavioral interventions to reinforce healthy eating and exercise habits Consideration of pharmacotherapy with U.S. Food and Drug Administration (FDA)- approved weight-loss drugs, if appropriate For individuals with lifelong, morbid obesity, participation in a program within the last five years is sufficient if documentation of six months is available and reasonable compliance with the weightmanagement program over an extended period of time can be demonstrated. However, diet programs/plans alone, such as Weight Watchers®, Jenny Craig® and similar plans, are not considered physician-directed weight-management programs and do not meet this requirement. Similarly, physician-directed programs consisting exclusively of pharmacological management are not sufficient to meet this requirement. • Recent evaluation by a multidisciplinary team including: A thorough medical history and physical examination. An evaluation by a licensed mental health care professional that specifically addresses any mental health or substance abuse diagnoses, the emotional readiness and ability of the patient to make and sustain lifestyle changes, and the adequacy of their support system. If an individual is already in behavioral health treatment, consultation with their treating clinicians should also be sought. A thorough nutritional evaluation by a physician or registered dietician experienced in the issues of bariatric surgery, who has had a meaningful conversation with the individual regarding the dietary and lifestyle changes required to ensure a successful outcome over time. http://www.cigna.com/customer_care/healthcare_professional/coverage_positions/medical/mm_0051_coveragepositioncriteria_bariatric_surgery.pdf

I also have Cigna and wanted to know the answer to that question also. I have about the same documentation as you, I went to my PCP in Jan, Feb and March, she put me on Phentramine and then I went to a medical led program called "loose it for good" for 4 months. I hope that will qualify, I still have the individual nutritionist visit and the gallbladder scan and one support group meeting this week and then I suppose they will submit for approval. I am so anxious to get this along!

I am really getting psyched up for surgery. I have completed my psychological exam and the 3 hour pre-op class; I still need the gallbladder scan, a group support meeting and the individual nutritionist meeting. I have completed my homework for the nutritionist of completing menus for a day in each of the 3 phases after surgery. That was much more difficult than I expected, I had to go to the store and look on the labels. The 2nd, 3rd were fairly simple, but phase 4 for the rest of my life was much more difficult. I do have some food allergies and that makes more of a challenge since I cannot eat egg, dairy, including cheese and no peanut products. I think I have it figured out. I think this process with the menus will be most helpful, at least I have had to think about it before I get there. I have Cigna Insurance and they require 6 months Doctor supervised diet, I am hoping that the program I enrolled in last summer will be ok, it was a program called “Loose it for Good” that a physicians group sponsored. My insurance did pay for it and it was coded for weight loss, however, I only went for 4 months, I had been to my regular physician for 3 months prior to that for phentramine. I hated that drug, it made me feel so mean! I hope all of you are doing well and I am so excited about this process, I looked at some "little" dresses Yesterday....I hope by next summer I can fit into some of them! I am certainly going to try my hardest! I was told not to loose too much weight until I am approved, but I want to diet so badly, Oh! I cannot believe I just said that, but I want to get started and get this weight off... because I feel certain that with the band I will be able to keep it off! That is what is most important to me about the whole thing! To be able to get it off and with the band and a change in lifestyle....keep it off for good!