Will the insurance approve me?

[tcbgirl 0]

Hi :wink2:

My name is Alisa. I am 32 years old with 3 little ones at home. I am in the process of getting the band approved by my insurance (Cigna). Dec 19th will be my last visit with my doctor since he is a nutritionist too, I don’t need to join the weight watcher. I am also having my psychiatric evaluation on Dec 17th which they said it would take 3-4 hours. What do they ask you anyway? Why does it take so long?

My questions for you guys that have been through this (getting insurance to approve). Do you think the insurance will approve me? My BMI is right at 40.5. I did not lose any weight with the nutritionist, instead I have gained almost 10 lbs due to the medicine the doctor put me on for shingles and I cannot lose it. I don’t have high BP, Apnea, Diabetes, High Cholesterol. The only thing I have is acid reflux which does not happen as often.

I am really looking forward to the band; however, I also do not want to get my hopes up if the insurance refuses to pay.

Has anyone been approved under the same condition?

Thank you for all of your help.

Alisa

[MacMadame 81]

You should look on Cigna's site for their bariatric surgery policy to see what their standards are. But most insurance companies will approve if your BMI is over 40 even without co-morbidities.

[bones 0]

I think my surgeon must have checked with my insurance company prior to having done all the prerequisites for approval and they told them it was a covered procedure.

I had to go on a 6 month medically supervised diet, see a nutritionist, and have a psych eval(its easy). Through that whole time I worried about getting approved. I had a BMI of 38 with no diabetes, high cholesterol,etc. The only thing I can think of that I had was bad knees( due to the weight).

After I finished my prerequisites and had all my info sent in

I was a nervous wreck. After a couple of weeks the bariatric program called and told me I had been denied because it wasn't a covered procedure which they did not understand because they had been told that it was covered.

The bariatric program told me not to give up and they told me some things I could try to get approval. I was DEVASTATED for 3 days. They called me back on the 3rd day and told me the insurance company had called back and said it was a covered procedure. So I went from having a covered procedure to a not covered procedure back to a covered procedure. The story gets even stranger: A lady I work with has a BMI of >40 and has the comorbities(diabetes, cholesterol etc) has gone to 2 separate bariatric programs(1 was the one I used) and they have told her its not a covered procedure under her insurance. We have the same insurance company

(through work). The only difference we can figure out is that I bought the more expensive plan and she didn't. We don't know if that would really make the difference or not

or its some arbitrary thing the insurance company came up with.

Good luck to you and I hope you get your band.