Venting about insurance

[Kimmya 0]

I am just starting the whole process. My insurance company (CIGNA) tells me that i need a letter from my doctor stating that he has been monitoring me for a diet and excercise program for at least six months. I didnt know that they would need this and now I may have to wait until 6 months is up even to see if I can be approved. And then at the end of six months I may have lost a few pounds and I wont be eligible for the surgery. Even though I know I will gain it right back because thats what always happens to me. (lose a few, gain double) I am very frustrated with the process. I am going to see my doctor today and hopefully he will be able to give me a letter sooner. You see, I am a kidney transplant patient also and have high blood pressure. My doctor has been monitoring my weight for a long time and is all for the Lapband. I dont know what my doctor is going to say but he might just give me the letter sooner but the thought of having to wait 6 months longer just pisses me off. Did anyone have to get this kind of letter from their doctor? What exactly did it say? I dont want to have my doctor write a letter and find out that it needs to be written differently.

Sorry if I rambled on but I just needed to vent.

[ugagirl 0]

I think most insurance companies require the six month pre-surgery diet. They want to know you can lose weight on your own. I started a doctor prescribed diet back in April and was able to lose 60 lbs in 7 months. If you have the determination to get this tool, you can do it.

Be thankful your insurance company will even consider covering the surgery. Mine quickly said "not covered" when I called to inquire about the coverage on my policy.

Best of luck in your journey!

[hnladue 7]

You're lucky!! I had to show 1 yr of phd support and 5 years of trying to lose (WW, Atkins, Southbeach etc) and THEN they had the nerve of requiring me to lose 10% of my weight before they would approve. OYE! But I got there. Just waiting on my surgery date.

[aubrie 6]

Don't even get me started. As I type this I am on hold for someone to help me at Aetna. I've been on hold for 55 minutes now...... I'm so angry. My surgery took 11 months before I got approval. I had it done last Novermber. They finally agreed to pay it at 100%. Well, I just got a statement of benefits saying they denied part of my hospital bill and now the hospital is trying to bill me for $9,971 !!!!!!! I think not.... I'm so pissed I could spit.

[bettyann29 0]

maybe Im wrong and you should check with your insurance company but I believe they go by the initial weight on your first visit.. they want to see that you can lose weight..

I have BCBS and originally they required 12 months of supervised diet so I put it off and was going to pay out of my pocket.. it ended up going on the back burner.. Then when I rechecked into it they had changed it to 6 months.. I decided that I have been overweight many years so 6 more months isnt going to kill me...

I found out today that I have been approved 100%!! and I actually lost a small amount of weight from my first visit..

It is a little disappointing to have to wait but 6 months really isnt that long..

[mrsgriffin2u 1]

I have CIGNA as well and am on month 3 of my 6 month physician monitored weight loss program. I haven't lost any weight (actually gained 3 lbs). I'm in the same boat as you so I completely understand. Thru my employer CIGNA is no longer covering WLS as of 12/07, but since is started the 6 month prg in December they are going to cover it. Hopefully I can get in by June to have my surgery.

I know that CIGNA also requires that you have a Case Manager to monitor your progress as well. That is one of their requirements, as well as a psyc evaluation, a nutritionist evaluation, a lap band seminar, and a surgeon consultation.

I hope this is helpful. Stick with it... I'm sure we'll all be glad we did this in the long run. What's 6 months when we have the rest of our lives to be healthy and SKINNY!

[NikkiD 0]

My insurance also requires a 6 month physician supervised program. While this is time consuming it does have its postives. For example meeting with a dietician and being able to discuss the types of foods that are good for me and how to eat in moderation has been very helpful. Also, getting myself used to an excercise routine has been a big thing. Take what information they give you and grow from it. It will help you in the long run. Look at it as a tool to achieve your goal.