CCRNonherway

No sleeve yet. I am down the road in Tucson, scheduled for the 25th at Northwest Med Ctr.

For those who asked why the surgeon wrote "yes" on her abdomen, it's in response to a patient safety goal of identifying the proper site for surgery. It was originally intended to prevent "wrong side" surgery (like the wrong arm or leg) but now many hospitals have the surgeon acknowledge his surgical site.

The policy states that another doc (not the surgeon) must clear you for surgery and recommend you for surgery. The policy is very clear on what must be submitted. Have you reviewed it? So sorry to hear about your troubles. Just be persistent and eventually you will meet all the requirements.

You are usually either weighed or asked your weight at the hospital for any surgery. This is so the anesthesiologist can calculate the right amounts of meds to give you. Nothing to do with weight loss. Sent from my iPad using VST

Me too! It's about 3 weeks away! Will be here before we know it.

From what I understand, your doctor's office "opens the claim" to get the claim number. Then Cigna "requests the clinical information" and then it goes to medical review. I initially got some letter saying they needed more information, and that's how my coordinator explained it.

It has to be supervised. Make sure to go over it with your doc or nut each month.

June 25th! Dr. Stephen Burpee Tucson, AZ

Now that I am "approved" for surgery and this is becoming a reality, I figured NOW is the time to post my story so far. I am 49, 5'7 and 235 at my highest weight. (Can't believe I actually wrote that down for public consumption!) That made me a BMI of 36.8. I had considered weight loss surgery off and on throughout the years of yo-yo dieting. My last good weight loss was about 30 pounds back in 2009 and I was lighter then. So that means I have put on about 40 pounds in four years. (Less than a pound a month, not too bad, right??!! Ha!) I have some lung problems, high blood pressure (if you would only lose weight, you wouldn't have to take these pills anymore....) and hypothyroidism. Too much for someone my age I decided and started considering the lap-band. I am a nurse and considered that to be "least invasive" and "easiest" to have done surgically. On November 28, 2012, I signed the hubby and I up for an informational seminar. While hubby wasn't interested (I'm hoping to change that), I listened to the doctor present the band, sleeve and RNY options. To his credit, he didn't try to sway anyone to any one procedure, but I had changed my thinking from lap-band to sleeve. I submitted my "insurance verification" form and left. In lateDecember/early January, I was contacted by the doctor's office and told that my insurance (CIGNA) did provide WLS benefits. I had started a post-holiday "kind of" diet about mid-January with Weight Watchers. I saw my surgeon for the first time on January 28, 2013. We discussed all the usual things and agreed that the sleeve was a good procedure for me. My only beef with the process was that the coordinator told me "All your insurance needs is the evaluation and 3 months of diet history. Just print out Weight Watchers and it will be ok." More on that in a minute.... From there, I had: EGD (endoscopy) on 2-4 and found to have a small hiatal hernia. Psych eval and nutrition eval on 2-13. In the mean time, I had researched CIGNA's bariatric policy and found out that I needed a lot more than "Just 3 months of Weight Watcher history." Rather than chance it, I went and got clearance from my PMD and met with a nutritionist for 3 months of a supervised diet. (2-20, 3-16 and 4-20...boy am I glad I started that "kind of diet" back in January!) Am now at 222 (fluctuating pounds.) My coordinator submitted my packet on about May 10th with a comment of "everything looks great...should be no problem." On May 17th, I was notified of denial...based on two points. My physician had failed to state that he BOTH recommended me for the surgery AND cleared me (he only recommended me....despite the fact I had asked him to do both.) The nutritionist did a summary report that detailed all three visits, with all of the components required, but CIGNA wanted it in three separate notes. At least it wasnt because of medical criteria! So...my coordinator got all that together and on May 21st, she submitted again, stating it could take up to 90 days, but probably not that long. The waiting is the hardest part!!! Well, today I got the news I was waiting for...APPROVED! It took 7 business days for the appeal. Now we are in fast-forward mode: 6-10: Pre-op meeting with surgeon to sign consents, etc... 6-15: Start of pre-op diet! (Not looking forward to it....) 6-17: Pre-op lab/x-ray work at hospital 6-25: Surgery I travel for my work (I am a healthcare consultant) and will be out of town three weeks between now and then, so it will fly by! I am so excited. I think now that it's a reality, my husband is concerned. I got the "If it makes you happy, it makes me happy" but I am not convinced. I know he is supportive of my decisions, but probably a bit insecure at the same time. food has always been a big part of our life and I have been slowly withdrawing from that over the last few months. Thanks for listening! I am so darn excited I just needed to share it with someone. I have told very few people. I will update after the surgery.

I just posted the link to their policy under another thread. It gives you exact requirements for the supervised diet. Hope it helps! Sent from my iPad using VST

All I can say is make sure your submission follows their requirements to the exact letter!!! https://cignaforhcp.cigna.com/public/content/pdf/coveragePolicies/medical/mm_0051_coveragepositioncriteria_bariatric_surgery.pdf I was denied my first submission and approved on appeal. The process took about a week each time. Quirky points: Your doctor must BOTH clear AND recommend you for the surgery. The supervised diet must be documented monthly for a duration of >= 89 days and contain documentation of diet, exercise and weight EACH month. Summary reports are not acceptable, even if each visit is detailed in the summary. My coordinator tried to reason with them but they would not budge until it was in the exact format they wanted. Nit picky she said! I'm so excited this is finally approved! In the scheme of things it went very quickly. Now Surgery 6-25! Eek! Sent from my iPad using VST

Congrats to you too! So much to do between now and then.

APPROVED!!!!! Surgery date 6-25!!!! Seems so soon! Took about 5 business days for appeal.

They were very quick with initial review. Less than 1 week. Just make sure your documentation follows the bariatric policy.EXACTLY. Mine was all there just not in the format they want it and they denied me. Now I am in appeal.

I travel abundantly too and have found it very difficult to meet the appointments etc...How much time did you take off before you could travel again?

How did you like Dr Burpee? I am in the approval process now.

I agree! Thank you. This waiting is the worst!

Submitted appeal on Tuesday. Hope it works this time!

Thank you! I hope these are easily resolved!

Took 7 days and got my round 1 denial. My doctor need to both clear and recommend me for surgery. He only recommended me (inferring that he cleared me too.) Not good enough, he needed to state both. My nut submitted discussion of the three visits in one report; Cigna wants it in 3 separate reports. So on the plus side, these seem like minor issues that can be easy fixed. On the minus side , it's disappointing that Cigna is so nit picky!

My doctor submitted to Cigna earlier this week. All paperwork followed their policy. We will see!

Does anyone know if insurance will cover complications for surgery done in MX (if there are any?)

Cigna has been paying for my nut visits. She is on their list of approved providers. I would start there.

Yay! I found someone local who will "see" me via Skype. She also sees out if state patients if anyone is interested, please DM me.