Worried about approval process

[luvelyn2hot2 0]

This is my first time posting on the site but I snoop around every once in a while and everyone seems to be knowledgeable about the sleeve and it's process.

Here goes......

I currently have a lapband (placed May 2009) and lately I have had extremely bad pain when eating and occasional vomiting. I am no longer a patient of the doctor that placed the band so I had to find another surgeon. I saw him two months ago and he checked the band to see if there was a slippage and he didn't see one. He unfilled the band to see if I would get some relief and I have not (mentioned this to him). We agreed to do a revision to the sleeve with no further testing on the band to see if there is possible erosion, etc. I spoke with the insurance person at the office and she is worried that I will not get approved because there is no damage done to the band but she will send my file off anyway. She said they might deny me because of non compliance with the band. I don't understand how when I have not gained my weight back. I am getting discouraged at this point because I feel like the new office is not doing all they should and I am not sure what I can do to help them get me approved. Any suggestions???

P.S I have Cigna Insurance

[mich 74]

I am also band to sleeve revision. My surgeons office submited insurance papers yesterday, and now I wait. My surgeon mentioned once that there is a chance it will be denied and it may take a few tries, he may have to do a one on one with my insurance. I think I have read this refered to as a peer to peer review? But he seemed confident that it would happen in the end. I believe the reasoning for the request is band intolerance. I am vomiting much more than I used to, and can never tell when it will happen.

Maybe the office worker was just having a bad day, and came across negative. I have read many times about people fighting to get approved, it may take time. But I find it hard to believe they can make us keep a device in us, one that was suppose to help us, but instead is causing us pain!

Good luck!

[luvelyn2hot2 0]

My file was submitted on 7/22 and i'm still waiting on an answer. I will keep my fingers crossed (and send up a few prayers) for the both of us.

[mich 74]

Have you called your insurance company? My surgeons office said it would be helpful if I call on Friday, she said follow prompts for pre approval, and ask if my surgery approval was ready. If yes, take down the approval number, call my surgeons office, and I'm all set.

I'll take all the prayers I can get, and send one up for you too.

[luvelyn2hot2 0]

I called the insurance company today and they told me the hospital is not a Cigna certified hospital! WTH does that mean! The lady at the doctors office told me they accept my insurance so I don't understand what's happening. Cigna told me the docs office will need to change the hospital and re-submit. I asked her what hospitals were certified and she gave me a list but the crazy part is the hospital where I was banded was NOT on that list. So, I asked her how they approved that hospital for bariatric surgery and she couldn't explain. I am starting to get discouraged!

[mich 74]

Don't get discouraged! My insurance, unicare, has in network and out of network. I just pay more for out of network. What does your surgeons office say about it?

The rougher the journey, the sweeter the reward!

[luvelyn2hot2 0]

My insurance denied it because the hospital is not a Cigna certified bariatric center. They gave me a list of docs and hospitals that were certified so I will have to start the process all over with a new surgeon. The doc office told me Cigna never mentioned that when they did the initial verification in June and there is nothing more they can do. So, it's on to the next one for me.

[mich 74]

Sorry to hear that. It's so frustrating how long things take, never mind throwing in office mistakes. And that seems like a big mistake on someone's part. It took me about a year to get my lap-band, and it will be just over 4 months process for the revision to sleeve. "Only" 4 months because I was already a patient in this Weight Center.

Good luck