So It Begins!

[innerme 26]

So I completed all my prereq's required for insurance on April 4th and my case worker just submitted my paperwork this last Friday, the 13th to the insurance company. I just got off the ph with Cigna to check to see if they had recvd my paperwork and they told me they had recvd it and it's being reviewed. I asked how long it usually takes knowing the standard answer is 20 days but the representative told me they usually have a answer within 5 business days! Oh how I hope that is true, as patience isn't a virtue I have been blessed with! I'm trying my best to keep my hopes up but know I will be completely devastated if I get declined. I researched my policy pretty thouroughly and I know I have met everyone of their requirements at least twice, including doing 2 six month physician supervised diets. the first six months was 24 months ago but there was concern that the insurance might reject asking for a more recent six mth diet, I didn't want to give any reason for the insurance to deny me so I went ahead and did a more recent six month diet and my case worker submitted both . I am a light weight compared with alot of people who have this done but I need to do this for my health. In Jan at my 1st visit to the surgeon my BMI was 39 and my weight was 233. My insurance requires there to be two comorbidities with a bmi of at least 35. My only concern is whether I lost too much weight in the last few months! I have diabetes, high cholesterol, GERD, I have a extremly large Hiatal hernia, and have found out from my upper GI that I also have a gallbladder full of stones. My weight for the last 6 years has consistently been within 10 pounds except when I'm on a diet and everytime I diet as soon as I eat normal foods the lbs lost wd immediately bounce right back to the previous weight. In November I decided once I went from being prediabetic to diabetic I had to make the decision to have surgery which I had been bouncing around in my head for about 4 years and had gone to previous sessions but until November it was more about my looks and not about my health. I have watched my mother suffer with diabetes for years and have seen her health deteriate and know how hard it is to control and don't want that for myself if I have a chance to do something before things get real bad I am going to do it. So in November i went to my first seminar and Jan had my 1st appt with the surgeon. I had my nutrition appts, psych eval, all my blood test, upper GI, all completed by end of Feb, only thing left were completion of a more recent 6 mth physician supervised diet which as mentioned earlier now completed. In Jan, after already reading day in and day out every forum about vsg to see what I cld find negatively, positively, and just educating myself as well as watching hundreds of youtube videos I knew I had made the right decision to move forward and that I def wanted this for myself. I came to the decision that I wasn't gonna wait to start making changes to my lifestyle to when I had the surgery that there were things I cld go ahead and work on that I cld control regardless if I lost any weight or not so I was going to go ahead and start making those changes now instead of trying to deal with them while recover ing with a life changing surgery when there were too many other things to deal with. The biggest change was my addiction to Diet soft drinks. Yes, I call it a addiction. I wd have a diet coke as soon as I got out of bed in the morning and always had one in hand during the day and had them until i went to bed. Since I knew I cldnt have them after the surgery I committed to quit the soft drinks. It took me two weeks before I stopped having headaches, and every so often I still have the desire occassionaly to buy one but I have replaced my soft drink habit with crystal light and keep it on me at all times. I started losing weight and exercising (walking a hour 3-4 times a week) and started losing some weight, I also know all the amt of Metformin I'm taking for controlling my is contributing to some weight loss as well. I have hit stalls 3 times and each time they have lasted for several weeks. My body is crazy and my weight will bounce 6-7 lbs thru out the same day instead of the norm 2-3. and When I lose it is like 2-3 lbs overnight. I hit stalls at 222, 218, 212, and now as of Sunday 208. At my six mth check up my weight when I left my house that morning sd I weighed 216 but when I got to the drs office their scales sd 210. I was like what the heck! I havent seen that weight on my scale, I shd have worn my steel toe boots. My surgeons office keep telling me to lose as much weight as I can before the surgery that it will be that much better and not worry about dropping below the 35 min bmi to have the surgery. They sd they use the weight from the 1st surgeon visit and that's why a weight history is required so the insurance can see how weight tends to keep creeping right back up . Oh I'm praying that is true because I have dealt with my weight the last 25 years I know right now that I have a goal and that I will have help to get me beyond that point when I have failed with diets in the past, I don't know what I will do if my surgery is rejected. I havent seen my weight below 201 in 25 years and know I need this. I'm excited that I'm finally at this point in the process but can't help from letting the negativity creep in with the what ifs. I'll be so happy when this week is over!

[frumpynomore 204]

Hang in there!!!! I can tell you are very excited about the journey you are about to go on and your anxiety's are getting the best of you. Deep breaths....soon you will be able to discuss your VSG weightloss with everyone on here!!!!

[FatGirlSlim 115]

hope you get the approval soon!!! please keep us posted!!!

[innerme 26]

Unfortunately I still don't have good news to report! I am so aggravated- I controlled myself and waited to contact Cigna to see if they had finished their review and they told me that my surgery has been denied because they haven't recvd the paperwork showing I have had 6 months of a physician supervised diet nor did they recv a letter of neccessity from a dr other than the surgeon. WTH! What in the world is my case worker even doing? I have tried getting a hold of her since Friday, left a message a few times and she hasnt even called me back? I'm so infuriated, after all the work I've done to get to this point and due to the incompetence of my case worker I'm sitting here on pins and needles just waiting. I tend to be a perfectionist in alot of matters and I have a complete intolerance to people who don't do what they are supposed to do. I wanted know complications with the paperwork so I reviewed Cigna's requirements numerous times to make sure that I completed every single thing that is required and because the case worker did not send it I'm sitting here with another 2 weeks wasted waiting! Does any one know If I can send documentation directly to the insurance company or am I totally dependent upon my surgeons office making sure they get everything sent in?

[Piplula 709]

Hi innerme! I too have Cigna. I would call Cigna and ask exactly what else is needed. Hopefully..you have made copies or asked for copies of all letters, labs, chart notes, ect. If not, request them from your case worker. Ask the Cigna representative point blank "what paper is missing and I will get that to you so we can resubmit the request. I had a great experience with my clinic and I had a checkoff list so I did everything that was asked of me according to the checklist which included 6 months worth of going to my PCP monthly to check in for weight checks and setting goals. If you know that you have met all of the requirements set forth by your Cigna plan, I would call Cigna and ask for all documents that were missing and ask if this can be resubmitted once you obtain them. Don't give up! I spent 8 months working on my requirements..once I knew I had everything..and I would call and recall...and recall again to make sure my patient representative had everything ..then my request was submitted and I got approved in 2 days. There were times some of my papers weren't sent, so when I would go to me PCP, I requested the forms while I was there and would personally fax the information to my VS Dr. And then I would call to make sure they received it. I know its a pain..but please...PLEASE don't give up on yourself...keep on keeping on! Never take no for an answer! Let us know what they say!!!

Sent from my DROIDX using VST

[innerme 26]

I finally got my approval!