cathychatts

I hope to have everything ready for insurance on Wed. I will have the gallbaldder then. I have done all the information meetings, nutritionist, phyc eval., sleep evaluation, group meeting, pap, mamogram, I have 5 months in a doctor supervised program and 3 months with my general doc when she gave me phentramine. I pray that is enough!:tt1: I have a BMI of 41 and have sleep apnea, osteoarthitis in the knees, gerd and asthma. Surely I will get approved! Good luck to you, I am always happy to see someone approved. I finally toldy my Boyfriend about this and I was shocked that he was so supportive. I expceted him to be a problem.:wub: His only concern was he wants to loose weight too.:thumbup: I told him I was afraid to tell him in case he only liked "fat girls" :wub: Silly me. :crying:

Today is my one-0n-one visit with the nutritionist, :unsure:and I have done all my homework. The only thing left on my list is the gallbladder scan and that is scheduled next Wednesday morning at 7am.:thumbup: Then the surgeon's office manager will submit to my insurance. I hope and pray that they will approve it on first try! I will certainly let you know, in the mean time I have been trying some of the protein powders and so far I love cholclate Muscle milk:drool5:. I am going to try to find a place to see if I can get assortment packs. I don't know about GNC they may have a trial pack of stuff. I am working today and the students are busy working so I can surf the net a little today:biggrin: Happy Easter to you all and good luck!:Dancing_shocked:

Roxy, From all I have read and gotten from talking to some reps from the Doc and the Insurance also, they want you to loose weight during the 6 month program, even if it puts you below the BMI, but I am going to try to get that in writing! I am on the edge of 40 and that was stooping to be 5'1" and wore heavy clothes and kept my heavy shoes on....

Mary, I don't know what they mean exactly, but I think they are talking about the most desirable support group. They refer to a mental health provider interested in "behavior intervention" and eating disorders, to me that sounds like group therapy. Funny, that is what they say is optimal, but they won't pay for that, only the evalulation. If you have what they are referring to you would have to go to the mental health provider. For me that is Megellan, not Cigna. Who really knows? I think that if they won't accept what i have already done, then my sugeon's office has a program that they do to get that requirement. I hope so anyway. Let me know what you find out. I am going to a group support meeting tonight and I hope to get more information there.

I have been stressing over the 6 month weight loss program requirement from my insurance and found this explination on the Cigna website. It does make it a little easier to consider why they require it. :biggrin: But I still hope I have already met the requirement! Here is the reference: http://www.cigna.com/customer_care/healthcare_professional/coverage_positions/medical/mm_0051_coveragepositioncriteria_bariatric_surgery.pdf The benefits of a preoperative weight-loss program include all of the following: • identification of those individuals who will be committed to and compliant with the short-term, long-term and lifelong medical management follow-up, behavioral changes, lifestyle changes, and diet and physical exercise regimen required to ensure the long-term success of this surgery • reduction of operative morbidity and surgical risk • improvement in surgical access with weight loss • reduction of the severity of obesity-associated risk factors, such as blood pressure, glucose intolerance, cardiorespiratory function and pulmonary function Access to a multidisciplinary team approach, involving a physician with a special interest in obesity; a dietitian or nutritionist; a psychologist, psychiatrist or licensed mental health care provider interested in behavior modification and eating disorders; and a surgeon with extensive experience in bariatric procedures, is optimal. Realistic expectations about the degree of weight loss, the compromises required by the patient and the positive effect on associated weight-related comorbidities and quality of life should be discussed and contrasted with the potential morbidity and operative mortality of bariatric surgery. With current state-of-the-art bariatric surgery procedures, patients lose an average of 50–60% of excess body weight and have a decrease in BMI of about 10kg/m2 during the first 12–24 postoperative months. Most long-term studies show a tendency for a modest weight gain (5–7 kg) after the initial postoperative years; long-term maintenance of an overall mean weight loss of about 50% of excess body weight can be expected

Roxy, I have Cigna and I am working on the requirement for surgery. I spoke with the insurance company rep and here is what they told me, I have copied and pasted directly from the Cigna website. I am hoping that I have met the requirements, but not certain. I may have to begin the 6 months again, I figure if I will I will just work on it, they say the 6 months is to show that you have the desire to live the life-style required after banding, they say that the band is only a tool that will help you complete your weight loss and keep it off, that the real work is what you do. The band is not a "magic bullet" I think they are right on with that, after reading most all the post on here, I think the successful ones are the ones that really work hard at the lifestyle changes. I hope you are successful and I also hope that for myself. Keep in touch and let me know how things go! Seems we have a lot in common! Cathychatts! (BE SURE TO READ THE FOLLOWING) The Following came directly from the Cigna Website: CIGNA HealthCare 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 one of the following: BMI (Body Mass Index) ≥ 40 for at least the previous 12 months. BMI (Body Mass Index) 35–39.9 for at least the previous 12 months with at least one clinically significant comorbidity, such as a serious cardiopulmonary problem, Type 2 diabetes, hypertension, coronary artery disease, or pulmonary hypertension that has failed to respond adequately to appropriate medical management. • Active participation within the last two years in one physician-directed weight-management program for a minimum of six months without significant gaps. The weight-management program must include monthly documentation of ALL of the following components: Page 2 of 28 Coverage Position Number: 0051 Vital signs, including weight Current dietary program Physical activity (i.e., exercise program) Behavioral interventions to reinforce healthy eating and exercise habits Consideration of pharmacotherapy with U.S. Food and Drug Administration (FDA)- approved weight-loss drugs, if appropriate For individuals with lifelong, morbid obesity, participation in a program within the last five years is sufficient if documentation of six months is available and reasonable compliance with the weightmanagement program over an extended period of time can be demonstrated. However, diet programs/plans alone, such as Weight Watchers®, Jenny Craig® and similar plans, are not considered physician-directed weight-management programs and do not meet this requirement. Similarly, physician-directed programs consisting exclusively of pharmacological management are not sufficient to meet this requirement. • Recent evaluation by a multidisciplinary team including: A thorough medical history and physical examination. An evaluation by a licensed mental health care professional that specifically addresses any mental health or substance abuse diagnoses, the emotional readiness and ability of the patient to make and sustain lifestyle changes, and the adequacy of their support system. If an individual is already in behavioral health treatment, consultation with their treating clinicians should also be sought. A thorough nutritional evaluation by a physician or registered dietician experienced in the issues of bariatric surgery, who has had a meaningful conversation with the individual regarding the dietary and lifestyle changes required to ensure a successful outcome over time. http://www.cigna.com/customer_care/healthcare_professional/coverage_positions/medical/mm_0051_coveragepositioncriteria_bariatric_surgery.pdf

I also have Cigna and wanted to know the answer to that question also. I have about the same documentation as you, I went to my PCP in Jan, Feb and March, she put me on Phentramine and then I went to a medical led program called "loose it for good" for 4 months. I hope that will qualify, I still have the individual nutritionist visit and the gallbladder scan and one support group meeting this week and then I suppose they will submit for approval. I am so anxious to get this along!

I am really getting psyched up for surgery. I have completed my psychological exam and the 3 hour pre-op class; I still need the gallbladder scan, a group support meeting and the individual nutritionist meeting. I have completed my homework for the nutritionist of completing menus for a day in each of the 3 phases after surgery. That was much more difficult than I expected, I had to go to the store and look on the labels. The 2nd, 3rd were fairly simple, but phase 4 for the rest of my life was much more difficult. I do have some food allergies and that makes more of a challenge since I cannot eat egg, dairy, including cheese and no peanut products. I think I have it figured out. I think this process with the menus will be most helpful, at least I have had to think about it before I get there. I have Cigna Insurance and they require 6 months Doctor supervised diet, I am hoping that the program I enrolled in last summer will be ok, it was a program called “Loose it for Good” that a physicians group sponsored. My insurance did pay for it and it was coded for weight loss, however, I only went for 4 months, I had been to my regular physician for 3 months prior to that for phentramine. I hated that drug, it made me feel so mean! I hope all of you are doing well and I am so excited about this process, I looked at some "little" dresses Yesterday....I hope by next summer I can fit into some of them! I am certainly going to try my hardest! I was told not to loose too much weight until I am approved, but I want to diet so badly, Oh! I cannot believe I just said that, but I want to get started and get this weight off... because I feel certain that with the band I will be able to keep it off! That is what is most important to me about the whole thing! To be able to get it off and with the band and a change in lifestyle....keep it off for good!

Karen, Lilo, Sister, Cindi and IndioGirl I like this group. Let's see... do I have everyone? There are two Karens, and I am Cathy. I am excited about this process and trying to avoid the negative people I encounter about this. That has kept me from telling a lot of people close to me. I don't want them to discourage me, one sister keeps saying how scared she is for me. I know she wants the best for me, but also is a little jealous that she doesn't have insurance to pay. Another sister is considering surgery but has chosen to use another Doctor and complete bypass. Funny how sisters can be. I want the band because, I will need constant support and don't like the idea that my stomach has been completlely changed. My regular physician says this is not at invasive as the bypass. Has anyone else had this kind of "support"? I have so many questions, but for now I need to concentrate on the "homework" my nutritionist gave me. I have to complete a day's menu for the 1st 3 phases of diets. Phase 1 -clear liquids,Phase 2 fluids with liquid protein,Phase 3 mushie food. We have to take these into a one-on-one appointment with her and also take a quiz to be approved for surgery. I guess everyone has their own requirements, but most seem to be pretty much the same. I hope you are all doing well and I hope to chat more soon!

Wow, I have made so much progress this week toward my quest for the band! I completed the psyc exam, it was un-nerving... I am glad that is done, but he did approve me, after saying I was too trusting... lol, it could have been worse. That took 4 hours and I was exausted. I don't know why it had to be so long. A written test and then an hour of interview. I also saw my GP and got a lot of assurance there, plus the documentation of the 6 months doc lead dieting, my insurance requires. I pick up the records from the OB/GYN and the sleep apnea docs also. All I have left is a group support meeting next Tuesday and the individual nutrionist meeting on Thursday and the gallbladder scan that should be scheduled next week. Then I will be ready to submit to the insurance! I hope that will give me the go ahead! I am aiming toward the end of April when my school has a semester break, that will be an ideal time! Good luck Karen and thanks for the support sisterc and lilo. I will look for you all on here! I will need all the support I can get and will look forward to being a support to others!

Wow, this site is amazing. I don't have anything to say except, I am glad you are here and think you are all wonderful in the way you support everyone! I hope u feel better soon Yazmin and I hope you don't give up. You are in my thoughts!

Soy is good for menopausal symptoms and I have used it for several years, it works! I think we will all need to watch ourselves closely because fat produces estrogen and as our bodies loose the fat we will also lose another source of estrogen. I wonder if that is what is happening to you. A young girl who is overweight will develop earlier and begin to menstruate earlier, due to the estrogen her body fat produces. So it stands to reason that as we lose that fat… we lose the estrogen. Try drinking a bit of soy milk or put it in a shake

Hello Everyone: I have been reading post for awhile and now getting active. I just figured out the ticker and ready to get on with the journey. I apperciate all those who have experienced what is in store for me. I look forward to and appreciate all your help and advice. I am a 59 year old Vocational College Instructor and have had a weight problem most of my life. Now, it is getting worse and my health is showing the consequences. I have been to the inital consultation with the surgeon, Dr. Kappa, in Kingsport, Tn and am now in the process of getting the necessary documents, tests, and consults. I have Cigna insurance. Any advice and encouragement will be greatly appreciated!

Hey everyone, I am just beginning to figure out all this forum stuff. I hav been trying to get a ticker on her...LOL.. Thanks Jessica for the words of encouragement. I really need this and am so happy to have found you!

Jessica: Congratulations on being banded. How are you doing? How long did it take Cigna to approve you? Did you do the full 6 month diet? As I said, I hope I have already met this requirement, as my regular doc saw me for 2 months and then I went into a physical lead program called "Loose it for Good" (which was a joke). I stayed there for 4 months. I am glad to be active on this board, as I am learning new things every day. I am a bit apprehensive about this process, afraid I will not be able to eat at all or have to be sick a lot. I am strong and healthy now, but need to loose those hundred pounds, they are quickly beginning to cause health problems, such as sleep apnea, my asthma is worse and the arthritic knees are giving me fits.... :biggrin:, maybe I am not as healthy as I think...:rolleyes2:. My worst problem is the GERD. I have to take 4 omeprazol a day, my Doc says I have "silent GERD" that causes a chocking sensation. I am on this road and I know I will need the support found on this site.

I have been lurking also, I am working toward my requirements and I also have Cigna. I can use a friend on here with the same insurance. I was told by someone at Cigna that most likely they will count two months with my regular doctor when she put me on Phentramene and then 4 months in a Physican directed program right after that. I am now trying to get all the other preliminary things finished so I can submit to the insurance. That will take about 2 weeks... I wish I could just get it all behind me. I still have the phyc evaluation, the gallbladder scan and the group meeting and the individual meeting with the nutritionist. All to be completed b the 17 of March. I am hoping and praying I can get the surgery during a term break in April. I am an Instructor at vocational college.

I celebrate my 59th birthday today and like all the rest here, I hope the last as a chub! I will go for my first consult on Monday and begin my journey!