dm5201

I have Cigna insurance and will have my 7th visit this week with my PCP (for diet). Just wondering if anyone else is going through Cigna. Hoping to get it submitted next week!

Can you give me reassurance on how long it took for your insurance to approve you for surgery?

Call the surgeon and ask his office for PCP recommendations who will be supportive of weight loss surgery.

How long did it take to get your insurance approved?

Any one had previous abdominal surgeries and been turned down for Lap-Band? I am mortified that I will be turned down. Anyone had adhesions removed abdominally and then had Lap-Band surgery? Thanks for your time. :thumbup:

Comment in: Surg Obes Relat Dis. 2006 May-Jun;2(3):417-8. Insurance-mandated preoperative dietary counseling does not improve outcome and increases dropout rates in patients considering gastric bypass surgery for morbid obesity. Jamal MK, DeMaria EJ, Johnson JM, Carmody BJ, Wolfe LG, Kellum JM, Meador JG. Department of Surgery, Division of Minimally Invasive Surgery, Virginia Commonwealth University Health System, Richmond, Virginia, USA. jamalm@mail.medicine.uiowa.edu BACKGROUND: Preoperative dietary counseling (PDC) before bariatric surgery is mandated by a growing number of insurance payers. Their claim is that PDC improves outcomes and postoperative compliance. We compared outcomes of GBP patients undergoing a mandatory 13 weeks of PDC (n = 72) to a contemporaneous group of patients with no such requirement (no-PDC; n = 252) who underwent operation between January 2000 and December 2002. METHODS: The PDC and no-PDC groups were characterized by similar male:female ratios (1:4 vs 1:4.6), mean age (42 years), mean body weight (324 lb vs 309 lb), and mean body mass index (BMI) (52 kg/m2 vs 50 kg/m2). The PDC group had a higher incidence of obstructive sleep apnea compared with the no-PDC group (41% vs 28%; P < .04) but otherwise the two groups had similar incidences of obesity-related comorbidities. The presurgery dropout rate was 50% higher in the PDC group than in the no-PDC group (28% vs 19%; P < .05). RESULTS: At 1 year follow-up, the no-PDC patients had a statistically greater percentage excess weight loss (67% vs 60%; P < .0001), lower BMI (32 vs 35; P < .015), and lower body weight (197 vs 218; P < .01). Resolution of major comorbidities, complication rates, 30-day postoperative mortality, and postoperative compliance with follow-up were similar in the two groups. CONCLUSIONS: The data demonstrate that insurance-mandated PDC is an obstacle to patient access for surgical treatment of severe obesity and has no impact on weight loss outcome or postsurgical compliance. PDC should be abandoned by the insurance industry. (©) 2006 American Society for Bariatric Surgery.

I have just been approved by Aetna for the Realize Band. I read our policy closely and saw that I needed to have 5 years worth of medical records showing how much I weighed and blood pressure, and so on. I went to the doctor all the time and all they want to see is that you have had a constant weight gain, loss, and so on. My weight only fluctuated by a few pounds. I obtained a copy of my chart back to 5 years. I checked that off my list. Next, I had to show that I had other issues and that I was being treated for it. I am being treated by the following: high blood pressure, sleep apnea (I use CPAP); if you have not had a sleep study, the surgeon may order that; reflux; and joint issues. The surgeon I went to has a nutritionist, exercise physiologist, RN, and psyc nurse on his staff. I went once a month for 3 months because my insurance requested it. I only had to see the psych person one time initially. Make a list or if your surgeon's office has one, get the list and work your way down the list. Surely, your surgeon's office has a staff that can help you successfully make this happen. Donna