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

[jenz75 0]

Hi- I also have Cigna. I am waiting for my pre-determination claim to be "approved".

I know that they want the 5 yr history. If you happened to be under 40 BMI during that time, either I needed to write an explanation or have some co-morbities (sp??) Rather sad- I was banking on high cholesterol!! LOL

Also, I had to have a "medically necessity" letter from BOTH my PCP & surgeon.

I went to a psychiatrist.. it wasn't a 3 hour tour. It was a general 45 min - 1 hr visit. Yes, I had to explain my childhood & such. But, she felt that I was "mentally" ok for my new challenge in life - lap-band!! =)

Anyways- at this time my case manager has it & I am waiting for her response. *she just received my med necc. letter from PCP** (which I have her contact # and email - I have been speaking with her weekly throughout this process)

Hope this helps..

Jenn

=)

[tcbgirl 0]

Jenn,

Thanks for letting me know about the 5 years history. The past 5 years for me was being pregnant (3 times). My cholesterol is right at 200. I do have acid reflux and the GI has to stretch my esophagus 5 years ago. With my 3 pregnancies, I developed gestational diabetes which give me a very high chance to develop type 2 in 5 years.

Now I am really scares that they will not approve me.

Alisa

[jenz75 0]

I got my call this morning..

Guess what!!?? I was APPROVED!!!

[tcbgirl 0]

Congrats Jen!

I am so happy for you :rolleyes2: Do you think if I ask my doctor and the surgeon to write a letter that I really need this Cigna will approve?

Alisa

[jenz75 0]

With my Cigna policy, I needed a letter of medically necessary from my PCP. (From a physician who was NOT performing the procedure; in my case, was my PCP. ) When the surgeon sends in his 1st consult claim, that's when he sent in his own med necc letter.

The ins processed the claim, sent back my policy info to my surgeon's office & said- this is what is needed. 6 months diet, leeter of med necc from other than the performing surgeon, 5 yr weight hisory. etc..

So- that's where/how I got my 2 letters of Med necc.

[aprildurham23 0]

Hey! I am 23 years old and got approved through Anthem Blue Cross and Blue Shield. My BMI was right at 40 as well (I had to put on snow boots and a thick sweater at weigh in to MAKE sure I was above 40. I have no co-morbidities that counted though. So yeah....I got approved! I bet you will too!

[tcbgirl 0]

Congrats to you too April. I hope Cigna is like BCBS that will approve me without my other health problem.

BTW, Jenn and April, I just talked to my insurance person about this and she said they want 5 years weight history but she did not mention about other health problem if your BMI is lower than 40. I don't think she knows what she is talking about, so I am going to gather all the info. myself and asked my pcp to write the ins. a letter mentioning about gestational diabetes and my cholesterol level which is right at 200). Please tell me that I am correct here, I am planning to summit all in for in Jan 2009, so that is mean I have to give them my weight history from 2005 on up right?

Thanks so much for your help,

Alisa

[aprildurham23 0]

I had to give 5 years of medical history too....actually I only HAD to give two but I gave five. I also made sure to list in detail all the diets I have ever tried, supervised by a doctor or not. It wasn't that difficult really.

[kimberlyea 0]

I am kind of in the same boat..I am heavy, but not totally unhealthy... I did have gestational diabetes with my last child. My family history is crazy, Dad died, diabetes/heart attack, sister died diabetes, Brother actually died last year, but they got him back, he has diabetes and had a massive heart attack, other brother had a heart attack 2 years ago and my closest sister now has diabetes. I am DOOMED! I need to do something about it and am so afraid of being turned down by insurance also.... what are they looking for me to say??I appreciate anyones experience and response...thanks!

[tcbgirl 0]

April,

When you said detailed diet history, you wrote it up or the doctor? I am asking because I used to go to LA Weight Loss, 2001 -2007 and today I called them and found out that the company (in TN) filed for bankruptcy. I called BBB and they said I need to file a complaint to BBB and also to PA Eastern Bankruptcy Court. If I cannot get my record in time, I probably have to write everything diet that I done before in the past. I hope that my PCP can write me up a good letter.

Kimberly,

Diabetes runs in my family too, heart attach due to high cholesterol too. I hope they take gestational diabetes into consideration.

Alisa

[ZiggyLove 0]

I also have Cigna and am awaiting approval. I've gone through the 6 month waiting period, did all the evals required now just waiting. Not once has anyone mentioned to me a 5 year medical history thing. Maybe because I have PPO? No idea. I've been waiting now for over 3 weeks for notification, apparently the surgeon's insurance person had some personal problems and was out of the office (how irritating, like nobody else in the office can submit insurance forms?). Anyway, let's hope we all get approval and can move forward from this! I'm really excited about it, and if I don't get approved I might just hit someone, haha.