KarenLR75

i got denied 7 times, i had to prove it was medically necessary, it wasnt because it was below the bmi its because they dont want to pay. insurance sucks, dont worry though the doctor knows what to say

Approved!! 🤩
My surgeon submitted paperwork to Cigna on Thursday afternoon and I received my approval Monday evening. I'm impressed with how quickly it was approved. I even received a letter yesterday stating that Cigna needed more information (it clarified that the letter was not a denial, just a request for additional records).
Here is a recap of my insurance approval process for anyone who is curious how it went:
Surgeon - Alisa Coker
Johns Hopkins Bayview
Baltimore, Maryland
SW: 192
Height: 5'0
BMI: 37.5
Procedure: Laparoscopic Sleeve Gastrectomy (aka sleeve or gastric sleeve)
Comorbidities: Diabetes, Hyperlipidemia (High Cholesterol), Hypertension (High Blood Pressure) **Worth noting, I take one medication for diabetes, and one low dose medication for hypertension. The hypertension medication I actually stated taking during this process.**
Requirements-
BMI = or >40 or = or > 35 with at least one comorbidity
3 Months of medically managed weight loss with primary care or registered nutritionist/dietitian (4 visits total - first was Dec 5th and then one each month Jan, Feb, March) **I have since read the verbiage change in Cigna's requirements and they have removed the 3 months of supervised weight loss. This may still me a requirement by your surgery team though, but it doesn't hurt to ask**
Upper Endoscopy - Standard test that checks for GERD, stomach ulcers, infections, and anatomy. This was an outpatient procedure. I was in the hospital for a total of 3 hours from arrival to departure. I was completely asleep during the procedure (they give you a top shelf iv cocktail) but recovery was much less than that of general anesthesia.
sleep Study - For sleep apnea and/or other weight related sleep disorders. Mine was an at-home test that was easy as pie. It was a wrist watch that connected to a few nodes and a sensor on your finger.
Psychological Evaluation - I went to a doctor who specializes in evaluations for bariatric surgery. It was probably the most nerve wracking of all the appointments because there's a strange looming in the air that these evals are hard to pass. **Tip - Tell the truth (your insurance will look at your medical records so if you have been treated for mental health but lie about it during your eval, they may deny you coverage) but don't unload your whole tragic life story on them. I have been treated for and hospitalized for bipolar and it didn't prevent my approval. They are basically trying to determine if you have a clear understanding of what the surgical procedure is and how your lifestyle will need to change. They want to make sure there isn't anything major that will intellectually challenged your results (major or unaddressed eating disorders, lack of understanding of the diet requirements, lack of motivation to lose weight), that you have a good support system at home, and that you are aware of aftercare requirements for life, possible complications, and after affects of weight loss on yourself and your relationships. In a nutshell, they need to know that you're aware of what you're getting yourself into, you are of sound mind, it was your decision to have surgery (not having the procedure against your will or at someone else's insistence), and you are equipped with the knowledge you need to be successful afterwards.
Nutrition Consultation - I was required to see the nutrition team at Johns Hopkins for a 90-minute appointment. We covered every aspect of the diet requirements from the two week pre-op, day before surgery, day of surgery, and each week after surgery until the 8 week mark. This appointment was very helpful. It was the most important component, in my opinion, because it really showed me exactly how my diet and lifestyle would change. I left that appointment with zero questions about how to be successful.
Letter Of Recommendation - A letter from my primary doctor (it had to be a doctor unaffiliated with the surgeon or surgeon's team) stating that I was physically able to have surgery, that I failed to maintain weight loss via medically assisted management, and that weight loss surgery was being recommended and was medically neccessary. This letter is very important as I have heard/read stories about insurance denials because the verbiage wasn't correct or one of the listed components wasn't included.
Blood Work - Usually done by primary care. This served as proof of hyperlipidemia and diabetes.
Once all of these were completed and the surgeon's coordinator received the paperwork, she compiled it into a package for review. She handed it over to a nurse on staff who double checks that everything is there and that it is in the right format with the right info. **Most surgical teams are well informed about what insurance companies look for. They will make sure your information is submitted correctly to prevent delays and denials.** Once the nurse gave her seal of approval, the coordinator submitted the precertification request to Cigna on Thursday.
Monday afternoon I received a letter that said additional information was being requested from my surgeon. I contacted Cigna to find out what additional info was needed (I was curious...and antsy!) They told me that the surgeon would receive a letter as well which would include details of the request. Well, that didn't satisfy me so I probed on asking if those details could be disclosed to me, since it is MY medical record. The Cigna rep (Charline) was extremely helpful. She contacted the precertification department for details and called me back that evening with news that I was approved. Johns Hopkins had provided the requested information pretty much immediately upon receiving the request. Low and behold, I checked my myCigna account and the black, in-progress status had transformed into the prettiest green APPROVED:)
Big props to Marie Day and the team at John's Hopkins for their attentiveness!!!
And that, my friends, is the super drawn out, nitty gritty process of getting approved for bariatric surgery via Cigna!
I know when I first set out I had a million questions so I tried to provide all of the info I always looked for but couldn't find. If you have any specific questions for me please let me know. I'm not a medical professional, this is simply info from personal experience, but I'm happy to offer peace of mind if I can!
Happy sleeving, y'all!

I'm working with Dr. Brian Long at the Nicholson Clinic. They have an office in Dallas and an office in Plano. The staff there is wonderful and I love Dr. Long. He's very knowledgeable and has been doing bariatric surgery for a long time. I've just started my journey and am waiting on insurance approval (fingers crossed!). The office staff has been amazing guiding me through the steps of this long and confusing process. I highly recommend contacting them!

Dr. David Provost was my surgeon at Baylor Scott and White in Temple TX about 2 hours south of DFW. He is one of the pioneers in bariatric surgery in Texas with decades of experience. He was in the Fort Worth area for many years before coming here to be the medical director of their program. As a nurse practitioner myself, I checked him out thoroughly before my first appointment. I think I was in very good hands since my sleeve went smoothly and I have had no complications whatsoever (I am 11 months out now). They have 2 really good nutritionists and some very knowledgeable RNs in their program and I have absolutely no complaints. They did all the work with getting insurance approval and making sure the requirements were met. Good luck to you wherever you choose....

This surgeon is phenomenal, and is highly skilled in all bariatric surgeries, including the standard of care Duodenal Switch (2 anastomoses).
Folahan Ayoola, MD
Weight Loss Specialists of Noth Texas
Locations: Denton, Flower Mound, Frisco

My surgeon was David Dyslin, in the Alliance area. He was at a general surgery practice in Arlington when I had my surgeries, but has years of bariatric experience. He recently went out on his own to focus on bariatrics. He's in temporary digs right now while his new offices are being built, but you're not ready for the surgery part for a while yet. Even though I had some complications, I have no reservations about Dr. Dyslin. His new number is 817-832-7227.
Also, I have Cigna and had no problems with it. Feel free to PM me if you'd like more info.

Panhandle Weight Loss Center Amarillo, Texas. Excellent reviews and personally zero regrets, everyone there is great.

Sent from my Pixel 3 XL using BariatricPal mobile app

Oh, that has easily been a year. or more. I did my share of research, decided to wait and try with weight watchers (again) for at least 6 months. But once the decision was made it was a no-doubt one.
I would seriously suggest to take a couple of weeks, see how it feels for you. Ask around, read up, listen to your heart. It is a irrevocable procedure, and also a life changing one. Are you willing to give up old habits? Do you really feel okay with no more carbonated drinks, careful with what you put in your mouth, never have drinks with your food and so on. You really need that determination, it is not an easy process and there WILL be bumps in the road. Some people have life long problems, others go through it like a breeze, but you will never be the same anymore, that is for sure.

Then again, if the decision clicks, and you are no longer in doubt, I would say go for it, and don't forget to enjoy the ride!

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 was a soda addict. The idea of giving up soda forever seemed daunting and unfair.
Now...meh...I really don't miss it that much. In fact....given the choice between a soda and a crunchy salad, I'd kill for the salad. Am missing crunchy veggies so so so much! Getting tired of eating mushy things. LOL:)

All of these things sound like me.

I had started the process with a Dr. from Eugene, Oregon. I did many of my requirements before they had a get together to explain the WLS. When I met with him personally, he wanted t do the Lap Band on me!! My hubby had the Lap-band for 13Years and it was a nightmare. So I decided it wasn't for me. Then my hubby had to have his band removed and we were referred to a DR 2 and 1/2 miles from home. We were discussing his procedure and I casually mentioned that I wished I could have WLS, the nurse said why can't you. I told her about the other DR. Well, I got an appointment and had my RNY on July 2, 2013. My hubby had to wait until Sept of 2013. His didn't go well. I have been successful with mine. It seems so strange that each Dr has their own guidelines. BTW my hubby eventually had his band removed and had the Sleeve done in June of 2016. (due to all of the scar tissue he didn't get to have the RNY). Good Luck to you!! Have a great Holiday!! And above all KEEP ON KEEPING ON!!

I used BodEvolve. Dr. Clayton Frenzel was great! He has a few offices in the DFW area. I went to Plano and the staff was wonderful. Good luck!

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.

I can't speak to some of your specific questions, because different doctors/clinics/insurance providers (from what I've read) have different requirements. My first, and most important recommendation is to get yourself to an information session or even a bariatric surgery support group in your area. They will be able to better fill you in on what the doctors in your area require.
My surgeon has asked me to lose 10% of my total body weight, not to prove that I'm committed to losing, but to help reduce the size of my liver. Many people I've seen on here don't have that requirement.
And as to what your husband said... the weightloss yo-yo cycle is just that, a cycle. What worked for your husband isn't necessarily what will work for you. Only a tiny percentage of high BMI people who lose weight in a 'traditional' way will keep it off long term, and the losing and regaining repeatedly is so hard on the body (of course, you know that already). WLS isn't a magic pill, but it is an effective tool.
I know that I probably haven't been all that helpful, but know that you aren't the only one facing these questions/fears. Information is power.