ML in VA

Hi! I was banded on 8/14 and and after 3 fills, now have 6.6cc's in a 10cc band. I FINALLY have restriction and can now only eat approx. 1/2 cup of food at each sitting. Hope this helps! ML sw 295 cw 268

I was recently denied by Cigna for lap band surgery due to "lack of medically necessity." My secondary insurance, Tricare Prime, has advised that they will deny me as well for the same reason. I've decided to self-pay and plan on submitting the bill to both carriers after surgery to see if I receive any reimbursement at all. Has anyone tried this and been successful? thanks, ML cw 280 gw 60

Hi everyone, I'm hoping I can get some good advice here. I was banded on 8/14; went for my first fill on 9/24 (3 cc's in 10 cc band). Today I am still very hungry and feeling very little restriction. I called my doc's office to schedule another fill. I was told that I could not get another fill until after November 19th (90 days post op). The first appt. available was 12/4! :biggrin: Does this sound right at all? In reading the boards, it seems most docs will give another fill if the patient requires it. I'm getting a little discouraged, although I am down 30 pounds since surgery date. Any advice would be appreciated. ML sw 295 cw 270 (?? - haven't weighed in 3 weeks; don't want to get discouraged)

Just came back from the support meeting. The fitness trainer who was supposed to faciliate wasn't there so it wasn't really structured. I guess I'll try next months meeting and then decide if they're worth the trek. Didn't have a preop diet other than clear liquids the night befoe. Hope this info helps!

I really like the UNJURY shakes - no after taste at all. My biggest learning is about the pain post op. I was the first surgery at 8:30 and was ready to be discharged by noon. When I left the hospital, I was virtually pain free. By the time I got home to Va Beach, the gas and stomach pains hit pretty quick. I didn't take anything other than tylenol for the pain. Boy was that a mistake! Lesson learned...take your pain meds to stay in front of the pain. After day 4 the pain subsided pretty significantly. Day 7...no pain at all. I totally understand all of your fears, but I think you'll find that the staff at Sentara does a great job to help alleviate your fears and Dr. T is the best at making you feel very comfortable. So no worries...you're gonna rock! :smile2:

I was banded on 8/14/08 by Dr. Terracina and I am doing great 7 days out. I'm on the post op diet for the next 7 days - liquids including broth and protien shakes and feel great. I'm down 14 pounds and can feel some restriction. Nothing but great things to say about Dr. T and the gang at WLSC; Sentara staff also rocks! Good luck on your journey. I'll gladly answer any other questions you may have! ML

I woke up this morning and dared to weigh myself...I know that I was facing a gain due to Water retention, bloat, etc. Anyhoo...I was banded on 8/14 and I'm down almost 14 pounds. Yahoo!!! Just had to share. ML

Thanks so much for the kind words. I'm feeling pretty good 5 days out; gas pain has subsided pretty significantly, although its still uncomfortable to burp and I tire pretty quickly. All in all - I think I'm on my way. I have my post-op on the 27th and then i can move to mushies - very excited about that! Good luck to you on your journey!:thumbup:

I had the same situation. I was initially denied by cigna (primary) and was advised by Tricare Prime (secondary) that they would also deny if cigna did. I ended up appealing cigna's decision and won.

Wow! Insurance really is a tough nut to crack. I have Cigna Open Access as well, but since my employer has a bariatric provision, I was able to at least submit the auth to them. They denied due to lack of consistent BMI and 6 month diet (i had docs for 4 out of 6 months). I appealed and they approved. I think it starts with the employer and how your insurance plan is written.

Thanks for your response KKS! I posted under a seperate thread that I had prepared to self-pay but shot off a pretty emotional appeal letter to cigna - they approved me 10 days later. Appeal it KKS...you will most likely be approved. I did not provide them with one extra piece of documentation when I appealed, which leads me to believe that they try to deny on the first try. Good luck to you! I am scheduled for banding on Thursday!!

Okay, so I started this journey in May 2008 after getting my PCP to agree that lap band is definitely something that I should consider, even though I had no comorbidities. I had done a 6 month diet with my PCP (I had missed 2 months), nutritional consult and psych eval and had documented my 5 year weight history. Everything was submitted to Cigna - within 6 weeks I was denied due to BMI being 41.5 but not for 2 years and lack of 6 month diet. I resigned myself to the denial, but shot off a quick, emotional appeal letter (unbeknowst to my surgeon) that basically stated I know I missed 2 doctors visits, but that was only because I was losing weight and yes, my BMI fell below 40 in the past 2 years, but that was due to a liquid diet that I tried. I also stated that I met all the requirements and reattached all of the docs previously sent and advised them why I felt I needed the surgery (family history of diabetes, high blood pressure, cholesterol and heart disease) and also documented my battle with weight for the past 10 years and basically said that Cigna coul expect to pay the claims associated with these diseases that would surely come my way. I prepared to self pay and borrowed 17K from my 401K. Surgery date was set for 8/14 and I was resigned to pay this large sum - even though I can't afford it. 2 days ago I received a call from Cigna's medical director assistant, indicating that they needed my nutritional consult resent. I faxed them this info and advised my surgeon's office what they asked for. They chuckled and said it was already sent and this is a stall tactic that insurance company uses. Today, I received a call from the medical director's assistant..APPROVED!! Moral of the story is sometimes a heartfelt appeal with the supporting docs works; don't give up. I hope my story helps someone. ML in VA cw 289

Hi Angela, I'm having my surgery by Dr. Terracina at Sentara Careplex in Hampton. I would love to chat as well!

Thanks so much, Stephanie. I think I may to keep some of my 401K money out for the new wardrobe that I'll be sure to need. I can't wait!

I'm scheduled for August 14th as well. I went from insurance denial to self-pay and today found out that based on my appeal...I'm approved! Yahoo! ML in VA:tt2:

Okay, so I started this journey in May 2008 after getting my PCP to agree that lap band is definitely something that I should consider, even though I had no comorbidities. I had done a 6 month diet with my PCP (I had missed 2 months), nutritional consult and psych eval and had documented my 5 year weight history. Everything was submitted to Cigna - within 6 weeks I was denied due to BMI being 41.5 but not for 2 years and lack of 6 month diet. I resigned myself to the denial, but shot off a quick, emotional appeal letter (unbeknowst to my surgeon) that basically stated I know I missed 2 doctors visits, but that was only because I was losing weight and yes, my BMI fell below 40 in the past 2 years, but that was due to a liquid diet that I tried. I also stated that I met all the requirements and reattached all of the docs previously sent and advised them why I felt I needed the surgery (family history of diabetes, high blood pressure, cholesterol and heart disease) and also documented my battle with weight for the past 10 years and basically said that Cigna coul expect to pay the claims associated with these diseases that would surely come my way. I prepared to self pay and borrowed 17K from my 401K. Surgery date was set for 8/14 and I was resigned to pay this large sum - even though I can't afford it. 2 days ago I received a call from Cigna's medical director assistant, indicating that they needed my nutritional consult resent. I faxed them this info and advised my surgeon's office what they asked for. They chuckled and said it was already sent and this is a stall tactic that insurance company uses. Today, I received a call from the medical director's assistant..APPROVED!! Moral of the story is sometimes a heartfelt appeal with the supporting docs works; don't give up. I hope my story helps someone. ML in VA cw 289

Room for one more? I'm ML from VA Beach and I'm scheduled for 8/14. Can't wait to get to know you all and learn from all of you!

Hello all, I have a date of August 14th! Woohoo!!:seeya: So excited to get to know you all and hear about your experience! ML from VA Beach cw 280 gw skinny jeans:thumbup:

I think its ridiculous that they don't cover this seeing how obesity is a disease! I'm self-pay at WLSC of Hampton Roads. I called them this morning to tell them I was able to secure a loan (401k) and had a date of 8/14 within seconds. No fuss, no muss! I'll be happy to provide any info you may need! Thanks by the way, for all that you do for our kids as a public school teacher!

Great point! Thanks for the reminder on the tax deductions.

Thanks Mary. I actually did speak with a Supervisor this past Friday. My surgeons office contacted Tricare as well. They are saying since I was denied due to not meeting "Cigna's requirements I will not be approved." So bottom line is...if I could dump Cigna..I'd be approved!! This is exactly why I am going to push hard for SOMEONE to reimburse me. What a nightmare!

So I'm not alone!!! Yeah! Its great to hear from someone who has gone through a similar experience. I am so excited to have this done and still plan on going after the insurance companies for some reimbursement. Please let me know how you make out!

No comorbidities and Cigna didn't require a sleep study so I didn't have one done. My PCM even wrote in her letter to my surgeon that although I am considered obese, I am considered "healthy." I suspect that word may have been a red alert for the insurance approver.

I am 5'9 and weigh 280 (approx. 120 pounds over high end of my ideal weight range) My BMI is 41.5.

I spoke with my surgeon about appealing. He doesnt think it will get approved, since his experience with Cigna is that they're the toughest. Since I have Cigna and Tricare, Im thinking that someone should reimburse if I self-pay. The primary reason for the denial was lack of medical necessity, but they also list that my BMI has not been high enough for 24 consecutive months. They also cited that since I did not have 6-months of doctor supervised vists, even though I was only missing one month. I'm so ready to make this change - both of my parents suffer from diabetes, hgh blood pressure and cholesterol. My mom just had the surgery and within 2 months is off all meds! I know that I need to do this now and I don't want to be at the mercy of an insurance company to make the determination on my life and health. I have the ability to pay (thank God) but I want the insurance company to be on the hook for something. Thanks for your replies and suggestions! ML