I knew it was too good to be true!

sassaay · January 31, 2004

Here I am only 3 days away from my surgery date and the surgeon's office just called... now I am sitting her in tears! Although my HMO approved the surgery, when the hospital went to my insurance company... they declined. I have Cigna HMO. My surgeon's office is now frantically trying to work with Cigna and my HMO to find out how this happened and to seek approval.

Please say a prayer for me. I didn't realize how badly I wanted the Lap-Band until I got that phone call and as soon as I hung up I burst into tears.

I know I can still appeal, but how could they do this only 3 days from surgery when I am sitting here looking at an authorization letter from my HMO???

I am going to try and keep my hopes up over the weekend, the surgeon's office said they should have a go/no-go decision by Monday noon. I am supposed to do everything as planned, so this means my "clear liquids" begin on Monday.

Thanks for reading my post and please keep your fingers crossed for me.

Alexandra · January 31, 2004

Oh, sassaay, what a blow! This will be hard to do, I know, but don't lose heart. If your carrier approved the surgery it's entirely likely that there's just some little piece of red tape that needs to be untied between the hospital and the carrier before you can proceed. You won't have to "appeal" because you haven't been denied. This is just a tiny bump in the road.

PLEASE come back and let us know what happened. If there's no good news please see if you can get the specifics on the situation--I'm an insurance broker and might be able to help untangle some of that tape, or at least explain it to you.

My fingers are crossed!! Try and have a good weekend, in spite of the situation. :confused:

Chickadee · January 31, 2004

Oh Anne,

I am so sorry you're going through this. I hope your doctor's office can get this ironed out quickly and that this will prove to be just a little bump in the road to a new you.

I don't post much, because I'm still sitting here in limbo waiting for insurance approval, but I do read your posts every day. They have been interesting and help me imagine how it will feel when I'm finally close to surgery. I will keep my finger, toes and anything else that will cross, crossed for you. Hang in there!

Becky

sassaay · January 31, 2004

Alexandra & Becky,

Thank you so much for your support and concern. About 10 minutes after my post, the surgeon's office called to say that Cigna denied me... they gave her a list of reasons why they would not cover Lap-Band... It's experimental, weight loss is slow (which is what I want), too much after care associated with Lap-Band, no real proof of its long term success... blah, blah, blah. Oh, but if I want Gastric Bypass... well go for it! I cried some more after that phone conversation and then I just got mad! I don't even want to go through the headache of an appeal... it is just too emotionally draining. I have been dreaming about this for so long and they just shattered my hopes.

Made a decision to use money out of my home equity fund and go to Mexico for a self-pay. This was my original plan because I just new the insurance company was going to let me down.

I called Dr. Kuri's office in TJ and from my hometown it is a relatively short flight to San Diego. The total cost is $8750.00 for the Deluxe package and I got round trip tickets for my Mom and me to San Diego for less than $100.00 each. My surgery date is set for 2/23/04... so instead of 3 days, I will wait another 3 weeks.

I am so glad that I have this site to share my hopes, dreams, frustrations, successes... basically the highs and lows. You all are fabulous and I appreciate the support.

Next stop... changing my auto signature!

Thanks again!:confused:

Alexandra · January 31, 2004

Oh, Anne, I'm sorry Cigna is so backward!! It's great that you have options and are taking the initiative. February 23rd is just around the corner. And the weather is great in San Diego at this time of year. :confused:

Let the countdown begin!!

marsha · January 31, 2004

Anne,

I was denied by my insurance too! I also decided to go to Mexico and I will be banded by Dr. Kuri on March 5th! You'll be banded just a couple of weeks before me! Don't worry the next few weeks will go by quickly and then you'll be in Bandlandia! :confused:

Keep us posted!

Marsha

sassaay · January 31, 2004

Thanks Alexandra! Yesterday I was a mess and I had dreams about my hurt feelings all night long, but this morning I am in better spirits. I know that the 23rd will be here soon and this time, no stinkin' insurance company is getting in my way. It is a blessing that I have options because I know so many do not.

Hi Marsha, who are you insured with? I see you live in Florida, what made you decide to go all the way to TJ for surgery with Dr. Kuri vs. going to Monterrey with one of the doctors there? Do you plan to get fills in TJ too? If so, maybe one day we can meet for a "fill" date? Thanks for your good thoughts and congratulations to you! I will be thinking about you as March 5th approaches.

Thanks again you two!

marsha · February 1, 2004

"who are you insured with?"

I'm insured with United Healthcare PPO.

" I see you live in Florida, what made you decide to go all the way to TJ for surgery with Dr. Kuri vs. going to Monterrey with one of the doctors there?"

Well, there were lots of factors. #1. Dr. Kuri has a great reputation. #2 It is almost double the price for me to fly to Monterrey then to TJ (hard to believe, but true). #3 I met someone on Lapbandtalk and we decided to go together (Jaejgirl). We both live in Florida and wanted someone to go with. #4 Price...it's hard to beat Dr. Kuri's price and he has a good reputation.

" Do you plan to get fills in TJ too?" I am trying to find someone closer for fills, but I will probably get my first fill by Dr. Kuri... I'll see how things go after surgery.

" If so, maybe one day we can meet for a "fill" date? "

The more the merrier! It's so much easier going through this with someone!!!!!

"Thanks for your good thoughts and congratulations to you! I will be thinking about you as March 5th approaches."

I'm thinking of you too!!! :confused:

Take Care,

Marsha

Mahoney · February 2, 2004

Hey Anne,

What an emotional rollercoaster! :confused: I just rode the same ride. I'm going south of the border myself, although it looks like I'll miss you by a day. I'm scheduled for surgery with Dr. Kuri on 2/20, and I'm flying back on 2/22. I'm looking forward to getting past all of the insurance garbage and getting on with getting healthier!

Best,

Bob

sassaay · February 2, 2004

Hi Bob,

I am right with you... I am still so upset about my insurance fiasco.

Anyway, all the best to you. Since you will be just a few days ahead of me, check back in when you are feeling up to it. I would like to know how it goes for you.

Take it easy and let's both enjoy a "smoother" ride from here on out!

sassaay · February 2, 2004

Hi Band Family,

First let me start by thanking all of you for being so supportive and keeping my spirits up over the last few days. I enjoy checking into this site daily and keeping up on everyone's daily events.

For those of you who have been keeping up on my drama... here is the latest. My original surgeon called me this morning to ask what she could do about Cigna HMO denying me. I said I wasn't sure, but I would be willing to try for an appeal... I didn't mention that I had already called Dr. Kuri's office in TJ and was planning on a trip across the border. She said she would call the insurance company and tell them that they are "forcing" me to go with gastric bypass even though she knows I won't accept that option... she would also tell them that gastric bypass is far more risky and expensive. She didn't think it would help, but she was willing to try. Well, about 3 hours later her receptionist called and asked if I was sitting down... I got approved!!! Dr. Machado spoke with the medical director at Cigna and got me approved. I don't know if the conversation went like she said, but I don't care bottom line is my original date is back on and I won't have to self-pay to get my beloved Lap-Band!!!

I am so happy, but now I am running around like crazy because I go in tomorrow morning and I had all but pushed those plans off for 3 weeks. Had to juggle everyone's schedules around, go back to my original request for time off work, etc.

Thank you, thank you, thank you... to all who helped me through this hiccup! I will check in again as soon as I am back home and feeling up to it.

All of you are the best!:confused:

Alexandra · February 3, 2004

YAYAYAYAYAYAYAYYYY!!! That is the best possible news, I am so happy for you!

So tomorrow is the big band day, huh? Please take care, take it easy, get some sleep, and most of all don't forget to come back and let us know how it went. Good luck, and CONGRATULATIONS!! :confused: