KarenLR75

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!

I have looked into bariatic surgery off and on (at a high level for about 6 years while always wishing my company would add bariatic coverage. Well, shockingly, they finally did. I have read a mix of things such as having demonstrated the ability to lose weight prior to surgery (will any of my previous weight loss attempts which were moderately successful with Weight Watchers or weight loss observed by my primary care dr. when I had Qysimia (sp?) prescribed for 3 months...was able to stop that vicious hunger which have a majorly large stomach entails. I lost 60 lbs. I just kind of find this as a sticking point. My own husband when I told him I was seriously considering the gastric sleeve said 'If I'd just listen to him and did what he did a few years ago, I'd lose weight'. I don't think it's a shock to anyone on here but NEWS FLASH - I KNOW A TON ABOUT "LOSING WEIGHT". I have lost hundreds of pounds in my lifetime. I am a BIG believer in low carb, low glycemic impacting foods. I can go without sweets. What my problem is...is that I have self medicated with food, grieved with food, filled my loneliness with food until I'm almost at my highest weight again of 380 lbs at 5' 6". I feel old, worn out and beaten down. I'm tired of worrying if I'll fit in a chair, I don't want to have to buy 2 seats on a plane. More than that, I want to have some quality to my life...the ability to walk through a store, to not feel this pervasive shame when I see the bulges of fat sticking out all over my body. I'm in late 40's. I've wasted 15+ straight years being severely morbidly obese with a BMI of over 50. I have a psychiatrist I see for other issues related to a child with additional needs and from losing my Dad, my best friend of 20 years and my Mom one right after the other. I know the doctors need some guarantee that you are 'ready' for this but the thought of having to wait months upon months upon months...just chills my blood. My back just started hurting so badly I cannot sleep..I wrenched a knee going down the stairs. I don't want to 'diet' anymore. I want a life.....do all the doctors make you STILL go through pre-loss drills? Or does the continual dieting I've attempted count for anything. Sorry, this is my first Christmas w/o my Mom and I'm just so weary of it all. I can't talk to my husband about it....he made it quite clear years ago that he is repulsed by me (well, maybe that's a harsh way to put it but the results are the same)...notice I didn't run out to have surgery for him. This is about ME and about ME ONLY.

Thanks for the replies. I should have added/qualified that during the times I was caregiving (and working 60+ hr weeks) for my father, followed by my best friend of 20 yrs (brain cancer) and then 2 months after she passed, it become evident my Mom had dementia so I went straight into caregiving for her and into one of the most traumatic ways to lose someone (outside of losing a child)...it is so hard to explain if you've never watched it first hand and been providing the majority of all personal care while you watch your loved one regress into an infant-mode.....during all this time, I self medicated with food. My beloved Mom was set free from Dementia this past year. In recent months, I no longer care honestly to eat. Nothing really sounds good. I will actually skip lunch and breakfast as I get so busy with work (yes, I know this is not good and must change) so the food challenges I am currently still battling is eating too late at night and then that '1 meal' not holding the hunger at bay 3 hrs later so I'm up at 2:00 a.m grabbing a banana, apples, sugar free jello. I try not to have what I call trigger foods on hand and I WILL eat them late at night. I'm know I still have some eating behaviors that must be changed but that constant, relentless massive over-eating drive that mastered me for over 9+ years has...I don't know...somehow faded. I still grieve greatly for my Mom....she was the sweetest, best Moms a person could ever have wished for...but after watching the horrible nightmare that is Dementia/Alzheimers, I am relieved she no longer is in the grips of it. I will try to find one of the groups near me to go attend some meetings. I forget who said this but yes, I actually did have the thought and maybe more than just the 2 of us did of "I'm ready now...WHY more hoop jumps". Deep inside I DO get it...I'm just still a bit overwhelmed

Addition: I hear True Results went out of business.....can anyone make recommendations of places and doctors in the North Forth Worth/Keller/Southlake/HEB area. Also, has anyone here had a gastric bypass or sleeve done with an IVC filter inside of you (filter for someone who has shown a predispostion towards blood clots...the place it in your inferior vena cava hence the 'IVC'. I was hoping that doesn't rule me out as although there is a risk of clotting with all surgeries, I actually have a device in me that ostensibly stops the clots from reaching my heart/lungs.