bee in my bonnet

Hi Everyone, I had my first consult yesterday for a band to sleeve revision. I really liked my doctor and nurse but was a little taken aback by the financial coordinator. I have Cigna. I would really like a band to sleeve revision performed at the SAME time. Per the financial coordinator, Cigna will not pay them for removing band and then sleeve performed at same time. They can only submit for one or the other. She said the preferred way to handle it is to first remove the band, then after NUT counseling, psych, etc, perform sleeve 90 days later. She said there was no guarantee I would be approved for sleeve after band was removed. I was kind of upset hearing this. When I finally got in to see the doctor, I stressed that I preferred to have revision done at the same time. He said they could try to work something out and took notes. Anyone else have this issue? I was a bit emotional yesterday after dealing with the financial coordinator. This was after she initially told me Cigna would NOT cover WLS for me, that I was excluded. I insisted she call them back and after I got a little weepy, she did. She then said "this is my lucky day" and I was NOT excluded. It was an experience, let me tell ya. Sooooo, let me know about the revision vs. removal and then 2nd surgery 90 days later. Sounds like this can be quite a process... Thanks to all!!

Hi All, I wasn't sure if I should post this in the insurance forum or this one. I will start here. I was banded in 2008. I have had problems from the beginning but nothing concrete has ever shown up on any testing. I throw up daily, occaisional chest pain and bad port site pain, espeically when I am stressed out. From 2008-2011, I only lost 25lbs, kind of an epic failure. In 2011, I started Medifast and then lost 80lbs. I had to stop it last year due to monthly cost of $350.00 and have since gained back 90lbs. My BMI is now again at 40.3. Not good. As none of my tests have ever come back with anything conclusive (no obstruction, no stricture), I am not sure if Cigna will deem my revision as "medically necessary". My doctor appointment is on friday and I want to go in prepared and to not say the wrong thing. If any of you has had a revision and NOT had serious complications, can you let me know? I am pasting my policy coverage below, what do you think of the wording? Reoperation and Repeat Bariatric Surgery : Cigna covers surgical reversal (i.e., takedown) of bariatric surgery as medically necessary when the individual develops complications from the original surgery such as stricture or obstruction. Cigna covers revision of a previous bariatric surgical procedure or conversion to another medically necessary procedure due to inadequate weight loss as medically necessary when ALL of the following are met: • Coverage for bar iatric surgery is available under the individual’s current health benefit plan. • There is evidence of full compliance with the previously prescribed postoperative dietary and exercise program. • Due to a technical failure of the original bariatric surgical pr ocedure (e.g., pouch dilatation) documented on either upper gastrointestinal (UGI) series or esophagogastroduodenoscopy (EGD), the individual has failed to achieve adequate weight loss, which is defined as failure to lose at least 50% of excess body weight or failure to achieve body weight to within 30% of ideal body weight at least two years following the original surgery. • The requested procedure is a regularly covered bariatric surgery (see above for specific procedures). NOTE: Inadequate weight loss due to individual noncompliance with postoperative nutrition and exercise recommendations is not a medically necessary indication for revision or conversion surgery and is not covered by Cigna. Cigna does not cover surgical reversal (i.e., takedown) or revis ion of a previous bariatric surgical procedure or conversion to another bariatric surgical procedure for ANY other indication b ecause it is considered not medically necessary. Thank you to all that can share. Best, ~Bee

I just found this Idaho support forum. Very cool. I relocated to Idaho last year and live in Meridian. I have been severly overweight for years and have finally decided to take the plunge and get banded. I have chosen Dr Robert Cahn out at St Lukes in Meridian. My first appointment is tomorrow afternoon and I am so excited. Are any of you current patients of Dr Cahn? I hear that he is really good. He operated on a friend of mine 2 years ago and took out her appendix. I have been going through all of the posts trying to get a good idea of what getting banded is about. This site is very helpful and I can at least go into my appointment a little more informed. Those of you who had to do a sleep study, how long did it take you to get in? I hear that it can take quite a while and it has me worried. Who did you see for a nutrionist and psych consult? Dr Cahn's office said they would give me a list of doctors but still, it would be great to get some input. I want to make sure that I pick the right doctor. I chose my regular doctor out of a phone book and I am not to happy. My BMI is 48 and she says that I should just be able to lose the weight without surgery. I have tried for so many years and feel that the band will help me to achieve my weight loss goal of 150lbs. The Idaho forum looks pretty small. I hope that more support is out there in Idaho! Let me know what you think... Christina:lol:

Thanks!!! I will post how my appointment goes tomorrow. Wish me luck... Christina

Thanks Jelbel, that is good to know. I hope that I don't need a sleep study... What doctors did they require you to see? Psych, nutritionist, PCA, surgeon?? Did you have to go through 6 months counselling first? I read here that some people do. I appreicate the info!!! Christina:teeth_smile:

Hey guys, I have just started the process and the insurance I have is Empire Blue Shield EPO. I am trying to gether as much info as possible before going to my first appointment on Thursday. My insurance covers the surgery (if I get approved) at 90% with a $1000 yearly maximum. My BMI is 48 so I don't think that I need any comorbidities but I am still nervous. I really don't want to do a sleep study becuase in Idaho, it can take months to schedule. Do you know if Empire REQUIRES a sleep study? I am good with every other appointment that I need to go to but I don't want to wait for months to get in. Thanks! Christina

I weigh more now than I ever thought would be possible. I am 5'5 and my BMI is 48. Can you imagine? My blood pressure was always low but now I am hypertensive. It is very worrisome that I have no energy and can't breathe when I exert myself. I called my insurance before calling a surgeon and I have to jump through a lot of hoops but I hope that I will qualify. I do have some questions but I am not sure where to post them. I have been scouring the forums all day and trying to get as much info as I can. Does anyone out there have Empire Blue Shield? Is anyone from Boise, Idaho who has seen Dr Robert Cahn? Can you actually feel the band around your stomach or do you get used to it? I am sooo excited and I hope to have the surgery done by October. I am going to try and race through my appointments. Has anyone only gone through 2 months of appointments or does it take longer? I see that some people have waited 6 months to a year, but I am just curious. It has been very helpful to read your nutritionist and psych tips, thanks. Let me know if I can just continue posting under my newbie info or if should go some other place. Thanks!!!

Hi Everyone, I am 34 yrs old and very new to the idea of getting banded. I just decided to look into it last week and my first appointment is Thursday. I am very excited at the prospect of having hope to get my life back. I live in Boise, ID and am very limited in surgeon choices. My appointment is with Dr. Cahn. I am hoping that my insurance will cover my surgery but there are a lot of hoops to jump through first. Is it Thursday yet??? :thumbup: Christina