HELP...what would you do? Advice/Opinions needed

[Sooverit! 1]

Hhello I've been extensively researching the Lap Band now for almost 2 years. I am a 37 BMI and 20 or so lbs. away from being a 40 BMI. I've gone through all the supervised diets and psych test, etc. you know the drill.

Like many people unfortunate to have this insurance company when they are seeking lap band coverage I've been turned down by CIGNA 3 times and now ignored by Obestitylaw.com...they just can't do anything more with my insurance because they are saying that the Lap Band is an "experimental" treatment and they don't cover it!

Being 245 pounds when most of my life I was 145 is destroying my self esteem and health. Here's my dilemma and I am looking for opinions because I just don't have anyone to ask about this:

Should I: (My primary care doctor is training to be a Fill Doctor with Fill USA)

1. Go to Mexico ..I like Dr. Rumbaut and did extensive research. Cost is only $9,000 total with everything flight, etc. (I have that $ and won't need a loan)

Problem: Deep down I'm really afraid as I will be going alone. What if something happens and I'm there by myself?

2. Take out a loan for $17,000 that is the cost for an out-patient Lap Band surgery at NYU Med center.

Problem: With the economy the way it is...I'm 49 do I want to have a loan like this? Not working at the present time. Do I want to go into debt again...will I even get the loan?

3. Go to Colorado...there is a doctor there who does it for $10,000 on an out patient basis and is experienced. I need to drag someone with me though as they don't allow you to leave on your own.

4. Continue to pursue and harass my insurance company when really I think they just won't cover me because I don't have the co mobidities they like.

5. Change insurance companies, wear 10 lb weights and do the 6 month supervised diet again.

I know I'm driving myself crazy...can anyone give me any advice?

thanks

m

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[MissBS 3]

Hi Sooverit. I am sorry you are having so many problems with your insurance company. You don't even want me to start my speech on insurance companies, and WLS, or this post might be called a book. It does sound like you have some options - don't give up on your dream. If your primary doctor is going to be trained to give fills, going to Mexico might not be a bad choice. Have you researched what you would have to do if any complilctions came up?? And if you go to Colorado, with a buddy, will that end up being as much as if you have it done there?? And once again.... if you have post-op check ups or any complications, would you have to fly back to Colorado?? There is no where closer to you that would do it for less?? I know I'm not much help - wish I could be more. Maybe a list of all the pros and cons of each one of your options would help. I wish you luck. I was a self pay and went to all of my loved ones for help. I didn't have a rich relative, but all of my not so rich ones kinda pitched in and helped me to get the band. They love me and want me to be healthier and around for awhile. I know not everyone has people to help - I am blessed. I will keep my fingers crossed for you - please let me know how it turns out. If you need someone to talk to - I'm a great listener. Becky

[LABBY08 0]

I haven't had the surgery yet, I am doing the insurance's 6 month diet. But I know a lot of people that have had very successfull surgerys in Mexico. If you have any problems wouldn't your pcp be able to help you. But you going by yourself, I don't think I would do. Just my opionion, hope it helped. Good Luck

[CMTurner 0]

I don't know what co-morbidities you have or not but I would make sure your physician is sending in all the paperwork needed and contact Cigna to make sure it is covered under your individual or group policy. Please see the attached link to Cigna's coverage position on bariatric surgery. Hope this helps.

http://www.cigna.com/customer_care/healthcare_professional/coverage_positions/medical/mm_0051_coveragepositioncriteria_bariatric_surgery.pdf

[Sooverit! 1]

Dear Becky: You are a blessing to me this morning as your kind words helped lift me a bit from this mood I'm in this morning. I can see why you have so many loved ones who are willing to prove their love. Congratulations on your excellent progress so far!

I love where you live too and your age ...close to mine! You're right, I do have to do more research about complications and being out of the country, etc. Also the trusted pro and con list I haven't even done yet! I think I have to focus on one choice at a time. I keep changing my mind...I finally stopped changing it about getting the lap band. One day I'd wake up saying to myself what r u nuts? Next day I'd catch a bad reflection of me in a mirror and say why I'm nuts not to do it. I'm doing it mainly for health reasons as I lost my twin sister to a heart attach only a few years ago. She was much heavier than me but I still am afraid of the same fate as I still have a little girl to take care of (she's 11:smile:)

Well thanks again and congratulations to you:thumbup:

[Sooverit! 1]

Thanks CMTurner....I saw this...they only recently changed the BMI criteria to being over 40 for 24 months instead of 12...sneaky people they are!

[April410 0]

Hi....I am so sorry you have to go through this trauma! I don't know how tall you are, but 245lbs is not a healthy weight for the "average" woman. I am around the same weight, at 5' 8".....

I think just based on the fact that your TWIN sister died of a heart attack you should be allowed the chance to get yourself to a healthy weight. Shame on Cigna!!!!! (my son in law has that insurance and after he fell from a roof, breaking his elbow and shoulder he should have had months of therapy following surgery and those cheap s.o.b.'s only allowed him 16 therapy sessions....at 2 or 3 a week, he obviously only got a few weeks of therapy and to this day his arm is permanently bent).....

Anyway, I see you live in New York. Have you taken your appeal to the New York State Department of Insurance yet?

I think you should sit down and write a very detailed letter of your weight, the problems it has caused you, the effect on your self esteem etc....and any comorbidities such as diabetes, high blood pressure etc. Get as many doctor reports as you can lay your hands on....everything from PCP, to Gyn, to endocrinologiest to heart specialist that you have seen.

It just sounds to me like your insurance is just being cheap and not thinking of your welfare.

When I spoke with my doctor's office (after I was turned down by my insurance) I asked them if it seemed better for the insurance to pay for surgery to cut my feet off once my diabetes got too out of control.......rather than pay for LapBand so that I can avoid further complications of type II diabetes???? I was so angry!!!!!

Luckily my doctor and staff appealed the insurance decison and I am now approved for surgery.....hopefully for early January. (my work schedule is too busy to take time off right now).....

Keep fighting!!!! Remember the squeaky wheel gets the oil!

[April410 0]

oh....and as far as "experimental".....the LapBand procedure has a CPT code 43770 which means "laparoscopy, surgical, gastric restrictive procedure, placement of adjustable restrictive device".... When my insurance initially denied me, it was for two reasons:

1) BMI was not high enough and co-morbidities were not severe enough.

2) the procedure was "not proven effective"

My doctor's office sent them all kinds of info on the LapBand and just how effective and successful it really is!!!

Also, I said get as many doctor reports as you can to show how your weight has climbed....or gone up and down over the years....how many attempts you have made to lose weight, etc. If you have been to Weight Watchers etc....try to get dates, how much money you spent.....etc....

As I said, write a powerful letter........not angry, but firm.....and demand that they make your insurance pay for the procedure.

I would even mention being left with no alternative but to go to Mexico - and perhaps putting your life in danger by going to an unknown doctor and hospital.

Hopefully you will be able to appeal to their sense of right and wrong.

[MistyD65 1]

Keep trying with your insurance company, but please don't consider taking out a loan if you have no job and no way to pay it back. You don't want that hanging over your head.

[Sooverit! 1]

April:"Luckily my doctor and staff appealed the insurance decison and I am now approved for surgery.....hopefully for early January.

Keep fighting!!!! Remember the squeaky wheel gets the oil!

Hey April: CONGRATULATIONS!!! You got approved! wahoo I am happy for you. I am also 5'8". Thank you so much for all your great advice and encouragement! There is actually a web site called Cignasqueakywheel.com ! I guess I have to do more work on this...just tired of it all right now.

Good luck on your upcoming surg. Labby! Yes Mexico might be what I do and if I go it will be in March for my 50th birthday.

Misty: You are right I don't need a loan hanging over me! I have to remember this. I could get another job especially if I lose the weight but who need to be in debt, it is the pits almost as bad as being unhealthily overweight.

[flowers 0]

My BMI was about what yours is now (depending how how they measure my height it can be cranked up I found). I went to Juarez because I live in Texas, so it was more convenient for me for $6,500. I ran into two sisters at my fill doctor who paid $6,000 each, so the price you are mentioning seems awfully high for Mexico. There are tons of good Mexican surgeons for $7K or less. You said including airfare, which you should be able to get a better rate if you shop around perhaps. I went to Mexico by myself as well. You can do it. I was never scared and they picked me up at the airport in El Paso, so they drove me to the hospital the day of surgery.

Its good to do your research, but dont overcomplicate things.

[Sooverit! 1]

Its good to do your research, but dont overcomplicate things.

Dear Flowers:

You are a smart cookie and you have me pegged without even meeting me! I do overcomplicate decisions and am way too hard on self. I don't even want to tell you how long it took me to buy this house I'm in! I'm thrilled with my decisions though but I have to trust myself more. Thanks for pointing this out.

Thank you!

M

[Boo Boo Kitty 3]

If I were you I would keep fighting the insurance company. BUT if you write a letter do not make it about you, they don't care about you. Sorry to put it bluntly, but it is the truth. You need to point out the benefits to THEM, saving $$ ect. Personal appeals will not help you unless you give them benefits to them. It is all about $$, let's be honest. Keep fighting, don't let them win! You can do it! Good luck! :biggrin: