Jen35

Congrats!! I'm hoping I'll hear something by the end of the week. Even if I'm approved, I don't think I'll be able to schedule surgery until February anyway due to work conflicts. Just found that out:(

So I called Cigna today to check the approval status. I was told I was denied because my doctor isn't in network. I called Cigna prior to starting this whole process to verify that the program, etc. is in network. I called the insurance coordinator at the office and she already knew. She said she thought my doctor was in network. Thankfully, the rep at Cigna verified that the other surgeon in the program is in network. So, I'm switching surgeons. The other will be in the OR with him (they always have 2 in each surgery), so no big deal. The insurance coordinator is calling Cigna today to switch everything so they can review it again for approval. Should know more in a few days (hopefully!). That was the only denial reason so, I'm hoping they don't come up with another reason to deny.

Congrats! You'll do great:)

Update - the surgeon's office just called to verify all my info before submitting it to the insurance. WTH?? I called on 12/18 and the coordinator told me it was submitted 12/17. I was upset about that because they could have submitted sooner. Come to find out, the letter was DATED 12/17 but hadn't been sent yet. So they are submitting today. I understand that they were closed a few days for the holiday and they're busy, etc. BUT it took them almost a whole month to submit. So now I may not know anything until mid to late January. And if they deny then it just pushes the date out even further. It just screws up my whole plan....

Update - the surgeon's office just called to verify all my info before submitting it to the insurance. WTH?? My last appointment was 12/6 with the plan that it could take most of December for the insurance to approve meaning a January surgery date. I called on 12/18 and the coordinator told me it was submitted 12/17. I was upset about that because they could have submitted sooner. Come to find out, the letter was DATED 12/17 but hadn't been sent yet. So they are submitting today. I understand that they were closed a few days for the holiday and they're busy, etc. BUT it took them almost a whole month to submit. So now I may not know anything until mid to late January. And if they deny then it just pushes the dage out even further. It just screws up my whole plan....

Oh no . Keep trying and stay positive. This waiting game (and insurance game) is so hard.

I'm so glad that you got approved. Good luck on the job search - hope things start looking up for you:)

Congrats:) Let us know how it goes:)

I think it is only giving out partial information and not going into detail. You are only lying if you give false information. Telling people that you are making healthier choices (diet and exercise) is not false. I don't feel shame in my decision to go ahead with the surgery, but I don't want to deal with other's judgement, insecurities, jealousies, (the list goes on) and then deal with the repercussions. I'm dealing with enough in my own life - I don't need that. You mention educating others. Sure, if I feel that a person is open to that (that is the key), then I may share more info. But people can and will use personal information against you. And many times no amount of education will change that. Case in point, you mention mental illness. My husband suffers from severe, debilitating depression. When he was first diagnosed, he was in the hospital off and on for a couple weeks while they figured out the right treatment, meds, etc.. He worked for a small company (too small for FMLA laws) and this was before HIPAA laws. They found out why he was in the hospital and fired him. While he was IN the hospital, knowing that his insurance would end 2 days later. Would they have done this if he had a heart attack? I think not. So, from this I learned that you keep personal information private and it can't be used against you. I share on a need to know basis. BTW, I work in human resources and I wanted to sue their a$$ off, but my husband didn't - he just wanted to move on. He's a much better person than me:) Based on the Americans with Disabilities Act, I could have shut them down and I REALLY wanted to.

Good idea with the quarters:) By my calculations I was at a 40 bmi at the first visit, but they measured me 1/2 inch taller than I thought. The one time I didn't want to be taller! lol

I was in a similar situation. I have Cigna insurance and they require a 3 month pre-op diet which I was doing with my surgeon. My first weight in I was at 39.7 BMI and second at 39.9. My nutritionist said that the insurance should approve as long as the last weight was 40 BMI. So, I made sure that it was Meaining, I ate chinese food the day before (salt=Water retention) and wore my bulkiest clothes. But I don't know if the nutritionist really knows for sure OR if that is true with your insurance. I also don't have any "qualifying" co-morbidities, but I have RA and fibro, knees pain (pain all over actually) etc. My info was just sent to the insurance for approval on 12/17 so I'm waiting to see. If I'm not approved, the office will automatically appeal. I will also go get a sleep study because I think I have sleep apnea and once that is diagnosed, it shouldn't be a problem getting approved.

I'm waiting Submitted to insurance on 12/17. Just waiting . . .

I also have Cigna, so I'm interested to see how long it takes. Mine was just submitted yesterday (12/17), but I thought the office had submitted right after my last appointment on 12/6. So 11 days wasted.

I know Biotene makes a dry mouth spray and you can get it at Walmart. Not sure if they will let you use it. I can't imagine what you are going through! It must be torture! I hope you heal quickly and can have something to drink soon.

Thanks guys:) I called the insurance today, but they didn't have it yet. They may have sent it in late yesterday. I will try calling later this week. Maybe they will know something then. I've just been waiting so long already.

I had the last of my 3 month pre-op appointments with the doctor and NUT on 12/6. My insurance requires a 3 month supervised diet before they will approve WLS. So I assumed that the information was sent in to the insurance shortly after 12/6. I called Cigna today - they haven't received anything. What?? I called my contact at the doctor's office and she said that they submitted the letter yesterday because the doctor was out of the office. Uggghh! I'm sure with the holidays, I won't know anything until after the 1st. I'm disappointed, to say the least.

Thanks for posting that. I'm pre-op and this is interesting to me. The stomach is much smaller than I expected!

I am pre-op and I have had the same kind of rash in that area. It was really red and sometimes itchy and painful. I thought it was a yeast rash and tried all the over the counter creams, but nothing helped. My doctor confirmed it was a yeast rash and the Rx cream took care of it. The Rx creams are much stronger so I would recommend that route. I also found a product online called InterDry which is a medical grade anti-microbial fabric with silver that wicks moisture away from your body. It also inhibits the yeast or any bacteria from multiplying. It was created for exactly this problem. It is a roll of fabric that you cut to size and place in the folds of skin. It works wonders!!! It isn't cheap but you don't have to buy it very often (you can use each piece for up to 5 days - depending). Making sure the area is clean and dry is the key. After I shower, I always use my hairdryer on the cool setting to dry "the area" before I get dressed. You can do this several times a day if needed. Hope this wasn't TMI, but I was miserable and these things helped me.

At my second appointment, when I was at 39.9 bmi, my NUT actually said "I won't tell you to gain weight, but drink A LOT of water right before you weigh next time". I gained a couple pounds and was at a 41 bmi at my last weigh in. I would have probably gained 10 lbs if I needed to. (and/or put rolls of quarters in my pockets, lol!). But you need to do what is best for you. I felt conflicted because I'm going to just have to lose those pounds again, but I really feel that I need this surgery.

I know how you feel:( I'm pre-op waiting to hear from the insurance regarding approval. I thought I was at a 40 bmi but the surgeons office measured me 1/2 inch taller than I thought. So, that brought me down to a 39 bmi. I don't have any eligible co-morbidities either, even though I have rheumatiod arthrisis, fibro and generally in pain all the time. I had a 3 month pre-op "diet" for insurance and the first 2 appoinments, I was under by a few pounds, so I did try to gain a couple pounds. I also wore my heaviest sweater and had my phone, change, etc. in my pants pockets. Is that cheating??? Maybe, but I was soo close. I also think I have sleep apnea and just haven't been diagnosed. If the insurance denies me, I will go get the sleep study.

I really like my tv too. My gym has the tv's on all the cardio equipment. I plan to go when there is a show I want to watch and I walk on the treadmill while I watch it. You don't have to go fast (slow walking is better than none). The time flies when I'm watching somthing I'm interested in. And I do this in the evenings (I'm not a morning person).

I am pre-op and I ordered a sample pack of Nectar protein powder (about $15). They give you a packet of most of the flavors so you can try them. The Chocolate Truffle and Cappucino are very good. I haven't tried the rest but they sound amazing - Fuzzy Navel, Tropical Cooler, Strawberry Mousse, etc. I will definitely be ordering some of these flavors.

I'm 35 years old and it never even occurred to me that I need anyone's blessing to have this surgery. My husband is supportive (thankfully), but even if he wasn't I would still have wls because I feel it is the best thing for me. I don't have a surgery date yet (hopefully January), and I haven't officially even told my dad. I mentioned it to my step-mom so I'm sure she will tell him but I didn't ask for his opinion. My brother had VSG 2 years ago and my dad's opinion then "If you can stay on a liquid diet before and after surgery, why can't you just do that without surgery?" He definitely doesn't get it. But if this option had been around 30 years ago, maybe my mom would still be alive today. She died at 39 from cancer (25 years ago) - her only risk factor was morbid obesity. I don't want that to happen to me. You really have to do your research and make an informed decision that is best for you. If you are young and/or rely on your parents financially, you may need them on board. If that's the case, share your research with them, have your doctor talk to them, etc. But don't give up if this is something you really feel is right for you.

Jussme - I know the feeling! The office should have submitted everything to Cigna on Friday (12/7) and it's just a waiting game now. I'm worried they won't approve. ArcusX - They don't make the information easy to find. If you want the full pdf document, message me your email. Originally, my surgeons office called Cigna to verify coverage and were told no. I called Cigna too and was told it was. The office called back and got a yes. Apparently, the rep was quoting the coverage for non-surgical weight loss. You sooo have to be your own advocate and keep looking until you find the answer.

I have Cigna and I was given a document outlining the general guidelines. I've copied/pasted some of the information. You will want to call to verify what is covered by your individual plan. Coverage Policy Bariatric surgery is specifically excluded under many benefit plans and may be governed by state and/or federal mandates. Please refer to the applicable benefit plan document to determine benefit availability and the terms and conditions of coverage. Unless excluded from the benefit plan, this service is covered when the following medical necessity criteria are met. Cigna covers bariatric surgery using a covered procedure outlined below as medically necessary when ALL of the following criteria are met: • The individual is ≥ 18 years of age or has reached full expected skeletal growth AND has evidence of EITHER of the following:  a BMI (Body Mass Index) ≥40  a BMI (Body Mass Index) 35–39.9 with at least one clinically significant obesity-related comorbidity, including but not limited to the following: o mechanical arthropathy in a weight-bearing joint o type 2 diabetes mellitus o poorly controlled hypertension (systolic blood pressure at least 140 mm Hg or diastolic blood pressure 90 mm Hg or greater, despite optimal medical management) o hyperlipidemia o coronary artery disease o lower extremity lymphatic or venous obstruction o obstructive sleep apnea o pulmonary hypertension •Medical management including evidence of active participation within the last 12 months in a weight-management program that is supervised either by a physician or a registered dietician for a minimum of three consecutive months. The weight-management program must include monthly documentation of ALL of the following components:  weight  current dietary program  physical activity (e.g., exercise program) Programs such as Weight Watchers®, Jenny Craig® and Optifast® are acceptable alternatives if done in conjunction with the supervision of a physician or registered dietician and detailed documentation of participation is available for review. However, physician-supervised programs consisting exclusively of pharmacological management are not sufficient to meet this requirement. •A thorough multidisciplinary evaluation within the previous six months which includes ALL of the following:  an evaluation by a bariatric surgeon recommending surgical treatment, including a description of the proposed procedure(s) and all of the associated current CPT codes  a separate medical evaluation from a physician other than the requesting surgeon that includes both a recommendation for bariatric surgery as well as a medical clearance for surgery  unequivocal clearance for bariatric surgery by a mental health provider  a nutritional evaluation by a physician or registered dietician Bariatric Surgery Procedures: When the specific medical necessity criteria noted above for bariatric surgery have been met, Cigna covers ANY of the following open or laparoscopic bariatric surgery procedures: •Roux-en-Y gastric bypass •adjustable silicone gastric banding (e.g., LAP-BAND®, REALIZE™) •biliopancreatic diversion with duodenal switch (BPD/DS) for individuals with a BMI (Body Mass Index) > 50 •sleeve gastrectomy (SG) •vertical banded gastroplasty