HELP WITH INS, comorbid

[eat-right 0]

Hi my very first post???

However I've been reading a lot of you guys things

And have been so inspired so I have a couple of questions too

Please if anyone has an ideal or a similar experience please post me back

We have Cigna insurance and the lap band is a approvably procedure

Just their requirements to me are a little vague?:tongue2:

Jan 10 2008 was the first month, and went back February 10th next visit was April 22nd within a year time I had attended six visits I went to A Physicians weight management program for a minimum of six visits with 8 weeks in between visits

Where he monitored my wt loss & gains took my BP..Temperature and heartrates prescribed medication & nutritionists menus and B12 shots so could that be equal to the sixth consecutive diet program they are asking for?

its been times with ups & downs

I've had some small success just doing things on my own just to gain back wt

Joining the YMCA going 3 days a week

lady's for weight loss meetings weekly meeting it's where we get together for supporting and doing competitions on who loss wt win money lol & doing so I had some success together I guess

I've lost 41 pounds now I'm at 198lb my BMI @ my surgery office 37 im 5ft3 with co morbid like being traded treated by PCP for hypertension taking two medications for that acid reflux taking one medication for that, sleeping pills for sleep apnea

severe back pain I Don physical therapy, steroid injections,the radio block surgery

MRI showed some arthritis in lower back

in past years Ive had kidney stones gallstones surgery on both

in June 08 cholesterol panel was high 206 HDL 44 the good chol.was to low & glucose/sugars 145 my parents were diabetics

Question is do you think I will meet the criteria cigna ins

with my Bmi being 37 almost 200lb 5,3

do you think I should obtain all my records ?

Would I be able to use the Dr. I just attended & now even still going too? let him fill them out?

or take the one the surgery wanting me to go to for 6 more mo? cinga " with no significant gaps " ins.??

I'm so sorry this has gotten so long just desperate to

Edited January 12, 2009 by eat-right
6 consecutived months diet

[Band_Groupie 3]

You need to make a call to your ins. co. to ask your questions and to get a copy of your policy. I don't know if you need a weight history (some need 3 or 5 years), since I didn't, but I can share my experience with the 6 mo. diet. You need to be OVER the minimum 35 BMI, which you are. With every ins. co. that requires comorbids (some require one, some two) you need to have at least one of the 5 big comorbids: heart-obesity related, hypertension, high cholesterol, type II diabetes, or sleep apnea. For any of these 5 to count, you also have to show that you're being treated for them...ie. if you are on meds. for your high cholesterol then it will count (if you're not, I'd talk to your PCP about starting meds now), and if you only need one comorbid then you're golden. The rest of the minor things only 'help' your case, they won't get you approved....I have asthma, osteoarthritis with therapy for my lower back, etc., these won't get me approved though. As far as the 6 mo. diet, it usually has to be done with the PCP or your surgeon's office with a nutritionist. There need to be 6 CONSECUTIVE visits (I couldn't follow if you'd had 6 consecutive monthly visits?) and you can't miss a month or you need to start over (just saw someone denied for too many days between one visit). For most people this visit is not just a weigh in, it also has to include review of the exercise program/progress and education (exercise being left off the monthly form gets many denied, make sure the Dr. takes good notes on diet AND exercise and the Dr. need to code this as a weight loss visit-insurance will see the codes. In other words don't combine a sick visit with one of your monthly weigh ins...again, I saw someone denied for this, if you have to make two visits in one week if your sick then do that). This diet has to begin within 2 years of your SURGERY DATE...if it's beyond that it won't count. Now, that said, I've seen others have more lenient ins., and excepting peoples WWatchers log books...seems like CA mainly has more forgiving ins., or maybe that's just my perception. If you don't get definitive answers here, try the insurance Forum. Also call your co., as an insurance expert who was also a patient on one site told me...even if you find someone in the same state with your same insurance co. every company's policy can be different. Talk to your sugeon's ins. expert as well. Good luck!

Oh, and welcome to LBT...lots of friendly helpful people here. Don't be afraid to post anything (I already asked all the 'dumb' questions and no one bit me!).

Edited January 11, 2009 by Band_Groupie

[Donnainva 0]

^what she said!

also, if your employer (if it's your insurance) has a knowledgeable HR person, talk to them. They may be able to explain what/how your insurance covers things in layman's terms.

Good Luck:smile:

[maggieas 0]

Hi, My advice to you would be to contact your insurance company and ask the specific guidlines that they follow to approve this procedure.(*lap band) That should clarify any questions. If not ask to speak to a superviser who specializes in this area of insurance approval for clients.

[eat-right 0]

Thanks for your help I'm just trying to understand what they mean by significant gap in that six months diet program i give them a call and just ask would that work

And the lady from Cigna says yes it may work to send us what you have she didn't sound confident

[eat-right 0]

Thanks for your support its my husband insurance and he's retired so I haven't talked to his HR person and a longtime thanks for your understanding

[socal 0]

I have a PPO ins that doesn't seem to require all the things that HMOs and other ins companies do; however, I would also suggest doing your research on a well-qualified lapband surgeon to enlist their help.

My lapband doc, Dr Feiz reviews claims for Blue Cross, and is very familiar with the requirements for ins co. His office and assistants have helped me streamline the process.

I've already had consults, endoscopy, and psych. Awaiting nutrionalist counsel...and then to my ins for approval? (hopefully) Pending approval, I will have medical clearance (lab, ekg, etc) within a week of surgery date.

Crossing my fingers for all of us to obtain approval!