6 months of waiting please help!!

[biggiesmalls 0]

:angry Me and my wife have cigna insurance she is an employee of cigna, i have been told when i went to my first consultation that it would probaly require a 6 month diet under doctor supervision, does anyone know of a way around this, and if she is an cigna employee can she find a way around this. please help.

[Keluliana 0]

It seems like they are setting you up for failure, doesn't it? They totally plan to give you the coverage, but they want to see you fail for a good six months first. I don't have Cigna, but my way around the six months was to write down every single diet I'd ever been on, including ones suggested by doctors, and submitted that to them. I think these can count, depending on how strict your insurance company is. It's worth a shot anyway.

[Alexandra 55]

This is a not-uncommon requirement, and frankly I think it makes some sense. So many people have this mental image that surgery is a quick fix, and it's not asking too much for them to be under a doctor's supervision for six months prior to surgery.

If this is one of the carrier's requirements for qualification, I can't see any reason they'd just waive it. Even for the spouse of an employee. It's really not so bad, and lets you get your mind in the right place to face post-op life. Just get started, and six months will be over before you know it!

[HelenC 0]

I have Cigna and they wouldn't pay AT ALL. My husband has BCBS and they paid 100% of my surgery, and 100% of my fills, after I did the 6 months of physician supervised diet.

My doctor just simply had me write down a month of meals (whether I actually ate them or not) and come in once a month to weigh.

You'll get through it!

[Alexandra 55]

I'm really very unsure how I feel about the six month routine. I understand and agree with what you are saying but I also see it the same as telling a diabetic that if they can keep their blood sugar under control for six months the ins co will let them graduate to insulin.

I mean, if we COULD diet and lose weight while keeping it off, we would.

I just have very mixed feelings about all of it.

The six-month supervised period is not about losing weight, it's about compliance. No carrier actually expects a morbidly obese person to lose enough weight in six months to no longer want or qualify for surgery. But their thinking is that if a patient with a dangerous medical condition can't even get it together enough to submit to medical care for six months, why should the carrier pay thousands of dollars for a surgery that the patient may just ruin through noncompliance? Bariatric surgery as a treatment relies very heavily on patient behavior, and if patients don't do what they should it's all just money out the window. And there are lots of OTHER patients who will comply and on whom the money would be better spent.

So it's about weeding out people who aren't good candidates, not about trying to get them to lose weight.

[Alexandra 55]

If it was as you say I would agree but FaithMD is an example. She had to lose "X" pounds before they'll approve her for a band. She had six months to do it, she didn't quite get that far and she was denied.

Her doc even wrote a letter to the ins co explaining that it was not totally under her control that she was unable to reach the goal. It did no good. She is trying again and hoping she can lose it by next month so she can try again.

Wow, that is a dumb situation. That carrier has its head, well, you know where.

[reqgoddess 0]

I personaly. think it is a bunch of crock. I think it is a catch 22 scenario. If you succeed and lose weight, they will probably say you don't need lapband, but if you fail, then you aren't a good candidate. I would ask them what is it you want me to achieve in this and what is it that you want to achieve in this, and get it in writing. This way, if you meet the criteria 6 months from now, they will have a harder time denying it on their letterhead or email address. Check the web page also, because many times they have "and/ors" in there that your doctor can work with. For instance, I was able to have my doctor write up all the times I tried while I was his patient (17 years now and MANY diet attempts). Many times the insurance companies will also have an "or have 2 comorbidities (I think it is called) like sleep apnea and high bld press, etc. They "help".

[faithmd 14]

Wow, that is a dumb situation. That carrier has its head, well, you know where.

Yes, MCare does have their head up there!

And I had to have 12 months of MD supervised diet. Not to make light of the situation, but Cigna at 6 months is a breeze.

I was on a medication that made me completely sedentary and mimicked the symptoms of depression (not caring, eating, sleeping short periods all the time), it was metoprolol (Lopressor) and I was on a fairly high dose of it to control my heart rate, and it didn't work. It was because of a heart condition that reared it's ugly head two months into my year of MD visits (and they're right, don't miss a SINGLE visit!) and I was affected by it until December of this past year. So by the time I was fixed, I only ended up with a month and a half to lose my required 5%. By then, I had added 22 lbs to my weight. The insurace considers your STARTING weight, not your high weight. So I had to lose the 5% PLUS the 22lbs I put on. But as it was explained to me, it is about compliance. Which I think is ridiculous, but what can I do? I am trying again next month and in the meantime, I'm socking some moola away and WASaBB is going to help me choose another surgeon if need be. (Thanks!)

About not missing a single visit: also make SURE that you see your doctor every month, not just weigh in with the nurse or MA. And the doctor has to write in their notes what you've been doing over the past month to try to lose weight. It can be as simple as saying you've started walking 20 minutes a day, etc... But it all must be documented.

[Candle 11]

I'm in month 4 of 6. It really does go by a lot quicker than you think it will.

I have had so many appointments for tests and blood work etc etc etc ... it takes about 6 months to get it all done - lol.