Newbie Praying For Insurance Approval

[Ciaobella 76]

Hello! This is my first post, but I've been reading up for about a week now. A little about me...I turn 40 later this month and I can't remember a time that I wasn't overweight. I wasn't always obese, but could always stand to lose weight. Over the years, I have dieted my way to obesity. My story is not unique...I, like most of you, have tried so many diets including Fen Phen, WW, HMR, Jenny Craig, Atkins, exercise, B12/6 injections, etc. Sure I've lost weight, but it has always come back...plus some. For years, I said I would NEVER do WLS. Yep, never say never! Today, here I am praying for insurance approval. I have Cigna PPO and have fulfilled all of their requirements including 6 mos medically supervised weight management (actually since Oct 2011) and i attend the monthly support group even though it's not required. I'm concerned because I'm seeking approval based on a BMI of 40-41 with no comorbidities. My doctor's office started the approval process on May 4 and within 4 days, I received a letter that they needed Info to substantiate the medical necessity of the surgery (they need the clinicals - whatever that means). So, now I'm waiting to hear if I'm approved. I'm not very patient...it's driving me crazy. I truly believe God wouldn't have led me down this path just to disappoint me, but I wish I knew what timing he has planned! Until then, I will enjoy reading about your successes!! :-)

[crystalcdbailey 13]

I pray that they will approve the surgery for you. Don't give up..........

[Ciaobella 76]

Thanks Crystal! I won't give up. I just hope I don't have to fight my insurance company. I've read so many stories about denials.

[TinyMamiOf3kids 1,280]

I hope you get approve. I never thought about surgery toll my scale said 200lbd then it went to 211lbs. I said no more fat chick! I wanna be slim & surgery is may 30. Think positive you will be approve & leave it in gods hands.

[Ciaobella 76]

May 30 yeah! You sound like me, but I got up to 225 and I'm only 5'2". I said, "Enough!" I can't afford to diet again and end up even heavier as I've done with every other diet I've done. I have two young boys (6 and 15 mos) and I need to be healthy so I can keep up with them!

[KevinsBabyGirl85 364]

Hoping and praying your surgery gets approved and you get a date soon!!

Sent from my iPhone using RNYTalk

[TinyMamiOf3kids 1,280]

May 30 yeah! You sound like me' date=' but I got up to 225 and I'm only 5'2". I said, "Enough!" I can't afford to diet again and end up even heavier as I've done with every other diet I've done. I have two young boys (6 and 15 mos) and I need to be healthy so I can keep up with them![/quote']

I have 3 kids. 15 years old girl & 3 years old almost 4 girl & 2 year old boy. That's my biggest motivation keeping up with my kids. They hardly go out cyz I'm tired & can't run after them so they have so much energy & I have non but it will change

[Mom0f3Boyzplus1 2]

Hello! This is my first post' date=' but I've been reading up for about a week now. A little about me...I turn 40 later this month and I can't remember a time that I wasn't overweight. I wasn't always obese, but could always stand to lose weight. Over the years, I have dieted my way to obesity. My story is not unique...I, like most of you, have tried so many diets including Fen Phen, WW, HMR, Jenny Craig, Atkins, exercise, B12/6 injections, etc. Sure I've lost weight, but it has always come back...plus some. For years, I said I would NEVER do WLS. Yep, never say never! Today, here I am praying for insurance approval. I have Cigna PPO and have fulfilled all of their requirements including 6 mos medically supervised weight management (actually since Oct 2011) and i attend the monthly support group even though it's not required. I'm concerned because I'm seeking approval based on a BMI of 40-41 with no comorbidities. My doctor's office started the approval process on May 4 and within 4 days, I received a letter that they needed Info to substantiate the medical necessity of the surgery (they need the clinicals - whatever that means). So, now I'm waiting to hear if I'm approved. I'm not very patient...it's driving me crazy. I truly believe God wouldn't have led me down this path just to disappoint me, but I wish I knew what timing he has planned! Until then, I will enjoy reading about your successes!! :-)[/quote']

Hey Maria, I hope you get approved. I think the national guidelines are your BMI has to be a 35 or higer with comobidities, or a 45 or higher without. I had no comobidities either, but my highest BMI was like a 49. I hear a lot of people are getting approved by doing sleep studies and finding out they have sleep apnea. That might work for you. Right now it will totally be up to the board on your approval. Good luck with everything and keep us posted.

[Ciaobella 76]

Thanks vamp and momof3! The guidelines for my insurance are 35 with comorbidities and 40 without. My highest was 41 and after the required weight management program, I'm 39, so very borderline. Not sure I could swing it as a self-pay, so all I can do is hope, pray and wait for good news!

[Mom0f3Boyzplus1 2]

Thanks vamp and momof3! The guidelines for my insurance are 35 with comorbidities and 40 without. My highest was 41 and after the required weight management program' date=' I'm 39, so very borderline. Not sure I could swing it as a self-pay, so all I can do is hope, pray and wait for good news!

[/quote']

Oh, we'll then you have nothing to worry about. They do not care if you have lost weight and lowered your BMI, all they care about is what your highest BMI was on record. If yours was a 41, then you should have no problems with your approval.

[Ciaobella 76]

Let's hope you're right!!! :-)

[Ciaobella 76]

So my doctor's office called on Tuesday to say they are still working on the medical necessity letter (i hope they are making a good argument!) and asked me to request medical records for last five years (a progress note from each year) showing DOS, weight and BMI. So I'm in the process of requesting records from every doctor I saw from 2008 until now in hopes that a couple will send info quickly, but this will add another 7-15 days before submitting to insurance. Still moving in the right direction albeit slowly! Lol

[Ciaobella 76]

Well it's been a long couple of months, but after having to switch doctors and redoing some stuff, I AM APPROVED!!! I received the wonderful news yesterday a week after my awesome new doc submitted to Cigna. September 10 is my big day. So excited and a little nervous too!

[plgondeck 6]

So glad to see God is your strength! Then why impatient! Let it happen and if it is meant to. E, it will be!

[Ciaobella 76]

No doubt without God, this process would have driven me crazy. I was reminded when i had to switch doctors that I'm not the one in control. His plan is so much greater. I was frustrated with the office staff of my first doctor, but EVERYTHING has been smooth sailing with my new doctor and I love him! Now I have to figure out what Protein Shakes to get, Vitamins, etc. because I only have 4 short weeks to go!!