KarenLR75

CONGRATS!!!! So very happy for you!! Have you posted on another thread as to how it went, how you're doing, etc. You've been on my mind a lot lately. As I drug our infamous 0051 coverage plan into my surgeon, I mentioned on how a woman in a completely different state with the SAME plan had also had her dr's office given the same /similar misleading responses but in the end, y'all pushed the paperwork through and you were approved!! I have appt w/cardio hopefully by end of this month to get a chemical stress test to get clearance. Hopefully I will have all "loose ends" taken care of and ready to submit after I see surgeon again @ the first of next month. CROSS FINGERS!!

Hey Vovo2013 - the young girl in the office told me, after I suggested that by next month, they just send the paperwork through and we'll let the "chips fall where they may"...she said the problem with that is if they 'deny' it than we have to do this 'peer review' with Cigna which slows things down and makes them very difficult. Honestly, and I do NOT say this to be unkind, but that young woman is very new, does not grasp terminology easily, is very very defensive...borderline hostile the last time I went in. I HATE this. I never wanted to hurt her or cause her distress, but I sincerely think she is in the WRONG position. Her badge says 'med tech', but I know she helps the office mgr do insurance verifications. She is truly out of her element and I wish for her own sake that she finds her niche. I also do not like being treated in an obvious frosty manner as it made the whole visit feel so very painful. It's not just insurance she has an issue with...she called today asking when I was going to get my bloodwork done. I told her, I told Dr Dyslin @ my appt on Tuesday (Tuesday of last week), that I had gone to Quest on the previous Friday and he wrote that down. He also asked for my cardiologists name as they were going to reach out to him. So when she asked about my bloodwork, I told her I guess the Dr. forgot to tell her but I had it done 2 Fridays ago. She then asked, well, do you still need to go? I mean...there is just something off/wrong about her responses to my replies. I told her which Quest location it was..and asked if I needed to call or did they. She said she'd call and then turned around & asked who I used for a cardiologist. I told her I gave the info to Dr. Dyslin but was happy to give it to her as well (FYI - it is on my new patient paperwork I filled out 2 months ago as well, I listed ALL doctors I saw, what for, and their contact info, Another odd response is when I was giving her the info she asked for on my cardiologist as I gave her the #, she said oh yeah, Dr. XXXX in Lewisville, yeah, I called and reached out to see if they need to clear you for surgery & they haven't called back. WHY ask me WHO my cardiologist is and then ask for his # so she can call and talk to him..when she has already done so? She didn't say "I've called your cardio and we aren't hearing back so can you call"...it was like she had no recollection of calling him @ first and not until I was giving her that she popped up with "oh, I called him". Sorry, things like this make me cringe when she calls...it's like there is a huge information/communication disconnect. :( :( :(

I definitely understand the concern; however, I have being working on losing weight, under supervision for more than a year now. I have lost 51 lbs. My weight loss has stalled due to knee and back issues. My ortho and spine dr's have encourage me to have bariatric surgery as both my knees need to be replaced. I've done all the PT that anyone can do. I took it slow and was determine to exhaust all available options plus I'm a personal believer in that you need to show you can have some personal discipline/skin in the game. The surgery is not a magic bullet. I consider it more of a nuclear detonation option. If it wasn't for finally finding out how painful a torn knee can be (after exercising too much) and then finding out I have so much arthritis in both knees that 2 diff orthos said I truly need knee replacement surgery (was SHOCKED)...I would NOT be going this route. After the past 15 months of doing supervised weight loss and finding out how it feels to be trapped by chronic pain, I made the decision (after therapy, etc.) that I wanted my life back MORE than I wanted to be able to eat 'any food' within reason. My surgeon gets this. I took the policy in with me to my 2nd appt with him and let him read it. I'm ALL for having requirements and ensuring a patient is READY - mind, body and soul for this surgery. What I have a hard time accepting is misinterpreted requirements. I'd be ok if my surgeon imposed his own requirements. I've met both his requirements and the requirements of my insurance (plus some). I'm now still stuck at 51 lbs lost even though my pool has warmed up so I can swim. The chronic pain haunts my nights now as well as my days. I'm so ready for a change. I depend on ALL of the professionals I see - my surgeon, my primary dr, my cardiologist, my nutritionist, my psychologist (specializes in eating/weight issues), my ortho, my spine dr, and my psychiatrist. They ALL feel I'm ready and I've talked to CIGNA now 4 different times. THEY all feel I'm ready, so we'll see on next month's visit to my surgeon. I'm not trying to RUSH anything. I have been thoughtful, mindful and have taken well more than 6 months to make sure this irreversible, irrevocable decision is the right thing to do. I hope this makes some sense. I agree with caution and I agree with even doing more than my insurance requires. After reading page 6, I have done everything that is suggested there as well. I pray/cross fingers that after my next visit, the paperwork is put through. Then we shall see...

oh my gosh, I'm SO HAPPY for you!! Congrats!! I'm not even sure I can get my dr's office to go ahead and submit. The young lady who is giving me the hardest time said "I spent 2 hrs on the phone with them just to make sure and they said it had to be 6 months, back to back..yada, yada, yada" She makes me VERY CONCERNED in that she never wants me to be part of the convo with my own insurance and always says that me calling makes things harder as I'm not "talking to the same people". Seriously, if the surgeon wasn't one I highly desired, I would RUN away (not just walk) from having to talk to this young woman.

Looking for any recommended doctors with a good/long track record performing gastric sleeve/bypasses within a 4 hour driving range of the Dallas-Fort Worth area. As with most people, one of my biggest concerns is not living thru the surgery. I've hung out here and have researched weight loss surgery for over 3 years now and am finally at a place where I feel more than ready for the surgery. I've been doing supervised weight loss with primary (was 390, now down to 340) and I don't want the work I've put into changing my way of eating, what I eat, and the weight loss I've had, not be counted. I also have knee surgery pending more weight loss and the pain has been getting shockingly worse despite the weight lost. Am at my wit's end in trying to find a surgeon I feel comfortable with. There is a surprisingly VERY VERY few bariatric surgeons in this part of the country whose reviews don't immediately make you rule them out. My company just added bariatric surgery to our insurance plan last year. I have CIGNA insurance - I hope they aren't awful about it.

I actually know a lady in a group I meet with who had surgery with Dr. Lyons. What I wasn't sure about is if he operates at a bariatric COE. I've heard this is the 'hospital' requirement from CIGNA. I guess I should call and ask as you are the 2nd person now to mention him. Thank you!

OMG...the dr's office called back and said they called CIGNA and were told that I had to do the 6 months, ,consecutive, yada, yada, yada and this is why it is best to 'let them handle these things' as I don't know the right people to 'talk to'. EXCUSE ME? I don't know the right ppl to talk to? I didn't call for 'basic coverage'. I called for the legally binding policy COVERING what their REQUIREMENTS ARE. Like you, I think/feel that these people should be very experienced with making these calls but the way she tried to read back policy 0051, I could tell she was very very very very confused! And she's saying to cancel the appt with the nutritionist for this month and 'just go' next month. She wants me to go back to my primary and get more 'notes' even though he wrote a letter detailing everything! I SO do not want to have a bad relationship with my doctor's staff! I never want anything like this. I just DO NOT BELIEVE this one person is truly comprehending how crazy all of this is..not even saying 'hey, this doesn't make sense...we should be hearing the same thing...let's do a conference call (which I suggested). I feel like I'm alienating them and I'm just at my wit's end here. I also feel bad for them and us as this is obviously something VERY VERY STRANGE related to CIGNA so we are all having to go through extra struggle and frustration because BOTH of us have had this same..."interpretation issue". I can't wait to hear how yours goes! I'm rooting for you. I also need to think how to...let my dr's office know..this is NOT personal and I'm not trying to argue. I am genuinely confused and I have dealt with Cigna so much in the past decade plus I work in a software industry that deals with healthcare, insurance..so I'm not a complete newbie. Am worried they now think I'm some desperate person that doesn't want to do what is required. All I have ever wanted to do was 1) Do what was required but more importantly 2) ensure that this decision was right for me and that I was 'right' for it. Right as in ready. Right in my head space, right in my willingness to work hard, right to meet and EXCEED the requirements from CIGNA as this was not an easy decision and I"ve spent 4 yrs exploring all options and am at peace with the work I've put in, where I'm at emotionally and mentally and the agreement and research with other specialists and doctors I've seen. 1 You reacted to this × Quote KarenLR75 Intermediate Member Pre Op 5 24 posts Location:TX Height:5 feet 6 inches Report post Posted just now Just got off phone with CIGNA. They reviewed MY specific coverage and stated that this Is NOT one of their requirements. We stepped through ALL of the requirements for their current policy which is effective thru 7/15/19. I have a downloaded copy of the specific and current policy regarding bariatric surgery. The CIGNA rep on the phone was mystified as to how the dr's office feels that the 'six months with a nutritionist' is a requirement. I called Dr. Dyslin's office staff back and was chided a bit for 'calling the insurance' which honestly upsets me. The young lady was nice but she is NOT proficient with reading/understanding medical verbiage and what it means. She said she and her office manager are confused YET they are looking at the same policy (policy 0051 for me) and they don't understand IT!!!! Said they will call insurance to check again but advised that I NOT CALL the insurance to 'get things confused'!! CONFUSED??!! I've been studying this for four years and since I am end up hospitalized every other years for the past several years I've become very INSURANCE PROFICIENT. I like Dr. Dyslin but if his staff is so GREEN they can't interpret to me what is CLEAR AS DAY to both myself AND CIGNA....I'm a bit concerned I may need a different office..and I really liked the doc!! HERE is the part they are hung up on which CIGNA said doesn't mean 6 back to back meetings with a nutritionist and I AGREE A thorough multidisciplinary evaluation within the previous six months which includes ALL of the following:  a description of the proposed procedure(s)  a separate medical evaluation and/or a recommendation for bariatric surgery from a physician/ physician’s assistant/nurse practitioner other than the requesting surgeon or associated staff  unequivocal clearance for bariatric surgery by a mental health provider  a nutritional evaluation by a physician or registered dietician surgery

You ABSOLUTELY NAILED IT. I posted before I saw your reply. WHERE/HOW/WHY ARE our dr's offices coming up with this requirement when it is NOWHERE IN THE POLICY AND CIGNA THEMSELVES SAYS "WE DO NOT REQUIRE THAT?". You don't happen to be in Texas as well do you? Honestly, going thru the policy with my dr's office person was PAINFUL. She was having trouble understanding what the 'WITHIN' 6 months part even meant. Then was told I shouldn't call...i shouldn't what??? If THEY Are confused, I HAVE TO CALL. Still mystified as to how both of our doctor's office are hung up on something that is NOWHERE in the stated policy which for me is policy 0051 which is currently in effect from 10/9/2018 to 7/15/2019. STUMPED BEYOND BELIEF. I thought it was usually a fight with insurance NOT with the doctor's staff!!! Medical Coverage Policy: 0051 Effective Date: 10/9/2018 Next Review Date:7/15/2019 Coverage Policy Number: 0051

Just got off phone with CIGNA. They reviewed MY specific coverage and stated that this Is NOT one of their requirements. We stepped through ALL of the requirements for their current policy which is effective thru 7/15/19. I have a downloaded copy of the specific and current policy regarding bariatric surgery. The CIGNA rep on the phone was mystified as to how the dr's office feels that the 'six months with a nutritionist' is a requirement. I called Dr. Dyslin's office staff back and was chided a bit for 'calling the insurance' which honestly upsets me. The young lady was nice but she is NOT proficient with reading/understanding medical verbiage and what it means. She said she and her office manager are confused YET they are looking at the same policy (policy 0051 for me) and they don't understand IT!!!! Said they will call insurance to check again but advised that I NOT CALL the insurance to 'get things confused'!! CONFUSED??!! I've been studying this for four years and since I am end up hospitalized every other years for the past several years I've become very INSURANCE PROFICIENT. I like Dr. Dyslin but if his staff is so GREEN they can't interpret to me what is CLEAR AS DAY to both myself AND CIGNA....I'm a bit concerned I may need a different office..and I really liked the doc!! HERE is the part they are hung up on which CIGNA said doesn't mean 6 back to back meetings with a nutritionist and I AGREE A thorough multidisciplinary evaluation within the previous six months which includes ALL of the following:  a description of the proposed procedure(s)  a separate medical evaluation and/or a recommendation for bariatric surgery from a physician/ physician’s assistant/nurse practitioner other than the requesting surgeon or associated staff  unequivocal clearance for bariatric surgery by a mental health provider  a nutritional evaluation by a physician or registered dietician

This! This is what I found when I was trying to 'check off' that I met all the requirements and yet at my appt with my bariatric surgeon yesterday they said CIGNA REQUIRED SIX MONTHS OF BACK TO BACK VISITS WITH A NUTRITIONIST and they MUST be sequential back to back visits or you start over!!!???? I have a year of supervised medical weight loss with my primary dr, a BMI of over 50, pysch eval clearance letter, even letters from other dr's like ortho's who said my knees must be replaced but I need to be at a BMI of 40....and yet I was told that Cigna didn't care about the supervised weight loss. They want me to meet with a nutritionist for SIX MONTHS to do WHAT? I AGREE I need to see a nutritionist although nutrition was always the topic of discussion with primary dr.....but for SIX MONTHS? That's a more rigid requirement than the weight loss and I worked on the weight loss for a year as I wanted to be very sure of things. Why do we get so many different answers..I have Cigna 90/10 plan (I pay extra for higher coverage as I usually am in hospital for 2 weeks every other year...why keep paying a 50K to 100K hospitalization bill for me when we can treat SOME of the underlying reasons and keep me OUT of the hospital?). I'm afraid to even call them. My bariatric surgeon is experienced...not sure about his staff as I just met them and he is building out a new office so they are co-sharing office space with an OB-GYN (like that wasn't uncomfortable)...should I call CIGNA myself or let dr handle? I really am now feeling leery of his staff

Hey Orchids&Dragons, Not sure if I recalled that you had CIGNA too. Sent you message after my meeting with Dr. Dyslin yesterday. I'm stunned and confused by what they said Cigna requires for seeing a nutritionist for 6 months...back to back consecutive months with no break..not even sure they care about the 1 year supervised weight loss I had with primary. Am just devastated. Am so confused by the differences I'm kind of seeing...did Cigna just change their policy? sher0929 - did you have to see a nutritionist every months for 6 months BEFORE you were approved for surgery. To me I figured I'd have a partnership with nutritionist and see them BEFORE..a couple of visits and AFTER surgery. I NEVER EVER Expected such a long and confusing requirement. Dr. Dyslin indicated there was never an 'appeal' that could be done with Cigna....but I thought I just read recently on someone else's post that they could appeal. SO VERY CONFUSED! AND MAJORLY DISAPPOINTED. Seems like 'hoop jumping'. I learned a ton about myself from the supervised weight loss that I initiated and all the work I've done and looked into the past FOUR years. Don't see the value of a nutritionist for SIX LONG MONTHS prior to SURGERY?!?! Don't mistake me...I know I need to meet with a nutritionist..it is the length of time and the fact that they don't factor in seeing one after as well...and that my supervised weight loss SEEMS like it means nothing.

Congrats! I'm curious if there are different 'flavors' of Cigna if you will. I have Cigna and just met with an in network bariatric surgeon and to my shock, despite my one year of supervised weight loss with primary doctor (length of time determined by MYSELF and knowing IF Cigna required it, I would more than meet this requirement; however, they are saying Cigna REQUIRES SIX MONTHS of visits with a nutritionist and they must be 'back to back' or you have to start all over??!! My primary dr has been a huge fan of low carb/keto lifestyle whether you are obese or not to help patients with other health issues so over the years and before my supervised weight loss, we would trade out info on the latest trend, counting macros, why you can stall and be in highest (deep purple level of ketosis), how many ppl don't realize too much protein can be converted to Glucose. As my weight loss slowed due to both knees now needing to be replaced (still in shock from that) and insurance only approving injections every 6 months, the difficulty I have getting around is devastating to me. WHY would they toss out the weight loss requirement and INCREASE to an unfathomable level, a requirement to see nutritionist BEFORE surgery for SIX MONTHS?! I have been preparing to ensure that I was truly ready for this for 4 years...doing the supervised weight loss especially while battling being able to get around and working 50+ hr weeks has been difficult but doable and I was so happy I hit a weight loss of 50 lbs (mostly from last 9 months). I fully expected to see nutritionist 1 or 2 times before surgery and then again multiple times after. I know I need to see one although I will be bringing them what I've been doing and having them many any necessary adjustments. I'm still stunned. I just found this out yesterday. Ironically both my primary and my surgeon feel that having this be such a long requirement w/o requiring the weight loss or maybe they require just a shorter period...is to discourage ppl from getting the surgery. I guess they'd rather pay my 50K to 100K annual hospital stays? Sorry, I do want you to know that I am above thrilled for you...but so very very confused and disappointed for me. Mexico looking better & better..

Thanks to all of you who responded. I finally feel like I have some options!

Hey Orchids&Dragons, someone on another thread had replied that they hoped you would see one of my posts as you liked your surgeon and they thought I would too. Thanks so much for responding. I have an appt. with Dr. Dyslin's office on 4/9/19. I put it a little bit out there as after discussing what I have been doing - supervised weight loss with primary doctor for 9 months now, already got clearance from psychiatrist - his office staff said to bring letters from both doctors with me to help get things moving along. I was a bit disappointed that they don't have a nutritionist on staff but I understand based on what you and his office staff indicated - they are in temporary quarters right now. They indicated that Cigna had the requirement for 90 days of supervised weight loss - I do have more than that but it is just so odd how the different plans and/or different dr's can have such different criteria. I did ask them about support group(s) and they indicated that the 'support' was done mainly via a private FB group. That works for me. I'll PM you on a few CIGNA questions.... Thanks so much!

Thank you for responding, Frustr8. Guess there are not a lot of outstanding bariatric doctors in the dallas-fort worth area or everyone who may have had their surgery around here is just busy, which I understand.

I've tried to respond 5 times and IE keep shutting down. Suffice to say I think someone noted that the clock started ticking after the first meeting with bariatric surgeon. I've been trying to get all of these other things out of the way while Ive been LOOKING for a surgeon. May have to rethink that. Thanks to all!!

Am particularly interested in your results with Cigna as I also have Cigna. Do you know what type of 'pre-op' weight loss hoops you have to jump through? For example, how long do you have to be on a supervised pre-op weight loss program, etc. Fingers crossed for you!1

I've told my primary doctor that I wanted to do supervised weight loss with him prior to asking my insurance. I'm concerned that if my insurance is one of the rare ones that does not care if you show evidence BEFORE surgery that you have the willpower/determination/etc. to loose weight on your own BEFORE surgery. I've heard some various input about being on a 'liver shrink diet'...some I've heard they are doing low carb. Was wondering if y'all were willing to share specifically what you were asked to do as part of a pre-op protocol. I totally realize that I may end up doing this twice if I do get approved for surgery. Hope this makes sense. I'm pretty tired...

Thanks for the reply. It's ironic that you mentioned Optifast...I'm not sure if you know it but back in the days of Oprah's talk show, that was the first major diet she did where she basically hid her weight loss under baggy clothing until they did the 'reveal show'. This was back in the late 80's or maybe early 90's I think. I did the same diet for 3 months. The only difference was we only got 5 shakes per day and broth if they felt it was required based on our blood tests The main goal was staying within the 800 calories of the 5 packs of protein shakes...I think this was 800 calories (if you drank 5 shakes)...is this right? So if you get a meal on top of that, is that where the additional 400 would be used to get you up to round 1200 calories? Thanks so much already for your time and help!

If you don't own an I-Phone/other Apple products (i.e. I have a Droid for a cell phone), what additional features, if any, would I be able to get from an Apple watch? In other words, is some of the functionality like getting calls/texts/music driven by having an Apple cell phone or will it work with ANY cell phone? Thanks!

For those of you that have undergone surgery and/or are still thinking about it, what are the top things that would come to mind (whether legitimate or not) that caused you to hold off on making the final and ultimate commitment to proceed? For me in prior years it has been the following (and please note that I'm not saying these are logical or rationale concerns and many are excuses...there is no right/wrong answer here). Assume that there are NO insurance/financial concerns. Also, some of the concerns/thoughts listed are still true for me today (namely #8, #5, etc.) 1) Oh Dear God, they slice away chunks of my stomach (bypass & sleeve) and it is not reversible (in case of the sleeve) 2) Surely instead of going 'under the knife' and the risks it will involve, I can commit to FINALLY losing the weight on my own once and for all 3) I'll never get to enjoy/eat 'XYZ' again OR I can only eat 2 TBSP's of 'XYZ' if I do this (rationale side says why wouldn't 2 TBSP's be enjoyable and also that food is 'fuel' not 'sport') 4) I'll never be able to have a drink again (FYI - I RARELY drink so this was kinda silly for me, but it was a thought) 5) What if something goes terribly wrong (often tied up with the thought 'what if I die') 6) The process takes so long, there is 'too much' I have to do...see multiple doctors, lose weight before, yada, yada, yada 7) What will I do with all of the loose skin (this one makes me snort out loud...don't ask me why I thought having 'loose skin' as opposed to 'fat filled skin' was an issue) 8) The side effects/issues related - dumping, malabsorption (sp?), etc. 9) My family/friends/coworkers thinks it's crazy risk...or crazy idea...or that I'm just too 'lazy' to actually "work at it" (and part of me used to be mad at myself for having to consider 'resorting to such drastic measures') 10) Regarding sleeve - keep reading we don't have history on the gastric sleeve like we do on gastric bypass, what IF something really bad shows up over time that we don't know now?

I searched for Bariatric Centers near where I live in Fort Worth TX and a place called BETTER WEIGH CENTER came up with a lot of positive google reviews, but their website either isn't very compatible with Chrome web browsers as it acted funny when I tried to sign up for a consultation and when I tried to look at info on the doctors, the page didn't budge. I'd prefer not to go to see Dr. Kim's place....my own reasons. Anyone else know a great surgery team/bariatric center? I'm just wanting to at least dip my toes into the Water and get to an info night...

I'm trying to find out if having an IVC filter inside me will disqualify me from having surgery, whether lapband, gastric bypass or gastric sleeve....

Thanks MsJlyne!