emb5126

Hello All!

I just received my first denial from Cigna for a panniculectomy. They didn't deny that it was medically necessary, just that it wasn't covered by my plan. I spoke to a fantastic rep with Cigna that urged me to appeal the decision but couldn't go into much detail about what they would want to see in the appeal. I vaguely remeber appealing for my band but it was 4 years ago and can't remember exactly what I did. The plastic's office won't help - apparently once they see there's a chance they aren't getting paid, they put their hands up. They won't even give me some tips of what the insurance company would want to see. I'm going to resubmit with the original documentation from the plastic's office, the lapband surgeon's notes and the photos along with more photos and a letter from my pcp. Is there anything anyone else has done to push that appeal through? Any tips or documentation I should include? I skimmed through other postings similar to mine and noticed that some members were offering sample appeal letters - does anyone have a copy I could check out?

Any and all help would be greatly appreciated!

Thanks,

-Emily

I was banded three years ago in April and lost 120+lbs. Within the past six months, I've had to have two unfills/refills, gaining back about 25lbs. I recently started the HCG and was very weary at first. I was constantly starving and feeling exhausted. It's day 11 for me and I've lost about 9lbs, after having one day of not following the diet exact (I had a tiny bit of froyo and popcorn.) I have noticed no difference of having lap band or not with the diet, comparing my results/symptoms to my mom's, who is not a lap band patient. I would agree that at first, it sounded a lot like a fad diet but personally, I've seen three friends who have gone on the diet, went through all three phases and stopped, gaining no more than about 8lbs back. As long as you stick to a healthy diet afterward, I see no issue in staying the relatively same weight. The only reason I went on the diet was to lose a quick fifteen before I go on vacation. Being on week two, my cravings and severe hunger has subsided... I've found some good recipes and got into a routine that has worked Definitely worthwhile!

Hello everyone! I was banded three years ago in April. I just had my first unfill because I was getting HORRIBLE heartburn and couldn't keep much down. He took out 2cc's and unforutnately, I gained back some of my weight. I got refilled yesterday but cannot keep anything down, including Water. I'm back up to my 7 cc's, where I was before, but it feels so much tighter. Has this happened to anyone?

hey banders!

has anyone heard of a lap band patient, a few years post surgery, join the military? i know this is obviously a question for my dr., but didn't know if this is possible.

thanks!

hey everyone from springfield! i also have dr. fiallo. he does great work... i just wish the office staff were a little more friendly. but with an office that busy, i can understand. i do have a question for ya guys, though... does anyone know how much a fill costs without insurance? i have recently become uninsured and need a fill soon.

and yes, i just read about the test... and i plan to start tomorrow morning. thanks :thumbdown:

i didn't mean the band being a cheat... getting more and more fills. the doctor made it seem like i had gotten too many fills in too short of time. which in turn, made me question myself.

if i thought getting the band in gnereal was cheating, i wouldn't have done it.

thanks for the reply... that is definately helpful! i actually didn't even know that could happen. hmmm... learn something new everyday! :thumbdown:

I had my surgery last April and within 6 months, I had about 5 or 6 fills. Everytime, it just seemed like I would get more and more hungry weeks after the fill. Finally, on my last fill, the doctor said this should be enough for a while. He was right... 5 months later, I was still feeling the restriction and had lost an additional 32 lbs. But lately, I'm back eating the same amount of food I was before my surgery because I'm ALWAYS hungry again. I've stopped going to the gym... due to lack of time. I KNOW all of these are bad decisions on my part, so I'm trying to get my butt back on track. I was hoping to get back in for another fill but I was wondering, from all of you experienced banders... how many fills did you have in one year? I know this is definately going to vary, because everyone's bodies are different but I just want to get an idea if my body is just using the fill as a cheat...

hey everyone.. i'm almost 4 months out after my surgery and have had 2 fills, it will be 3 next week. my problem is i've gotten really tired lately and have lost almost half the hair on my head. i slacked for a month or so on my Vitamins but have started religiously taking them again. has this happened to anyone else?

im going through the same thing right now.. i was banded on april 2nd and just had my first fill on the 16th and i don't feel any restriction. i also know that i'm not helping myself whatsoever with my eating habits. i really don't eat that much but what i eat isn't good. with my doctors guidelines, i was back on solid food by week three. and personally, if i could go back, i'd wait till at least a month after surgery to eat regular foods. i'm trying to kick my butt back on track by going to meetings, making a food plan and getting another fill asap.

I agree that Dr. Fiallo is very good... I just wish he had better bedside manner. I originally wanted Dr. Haag.. and I tried to request him, but I was already given to Dr. Fiallo.

hey everyone! i'm nineteen, from western mass and was banded a week and a half ago. even though it hasn't been that long, this was the BEST decision i've ever made. it comes with ALOT of changes.. i have to rethink my choices on food, going out to dinner.. haha i bring my carnation to parties now! haha but it's so worth it. i hope all of you get through your process quick and can enjoy this as much as i do!

i was banded last week.. and i don't find that ANYTHING helps the gas pain. i tried heat packs, gasx, walking around alot... nothing! a good ole' back rub from mom was the best. the pain finally went away today, day 6. just bear with it.. it'll go away.

i wanted dr. haag, too! he just seems much more in touch with his patients. i'm still feeling sore.. it's day 6 for me. today is my first day back to work so i'm trying to take it easy. how far along are you in the process?

mmmmmm.... cottage cheese, salsa and avacado. i cannot wait till i can eat that. i know what i'll be dreaming of tonight... hehehe.

yep.. i got banded last thursday. and i also had dr. fiallo. he's not the most friendliest of doctors, and their not the nicest staff to deal with. honestly, i think i've gotten better answers to my questions on here than from them. just wondering if anyone else felt the same way or if it's just me...

your only 9 days out and eating macaroni salad? wow... you're brave. my doctor said a week of liquids, a week of mush, a week of softer foods and then high Protein. i've lost 11lbs since my surgery and i didn't really do a pre-op diet. don't get me wrong, i'm happy that i've lost the 11 but there's noooo way i'm stopping now. not even for macaroni salad.

wow.. im glad im not the only one! i had my surgery last thursday and im still yet to go. my stomach is hard as a rock and i've taken exlax, milk of magnesia and benefiber.. but nothing yet. i was thinking that it because im still on liquids and that there's probably nothing to come out. i guess i'll just keep waiting.. unpatiently. hehe.

hey everyone! is anybody from western mass? did you use pioneer valley surgical?

wow.. everyone's doctors sound like they care about their patients haha. i saw mine a week before surgery... 10 minutes before surgery.. and now i won't see him for 6 weeks AFTER surgery. im feeling a bit neglected. but i have all of you lovely bandsters to talk to. hehe.

wow.. everyones directions ARE alot different. i'm from springfield, ma and my doctor's instructions are: one day of Water only, 7 days of Clear Liquids and Protein drinks, 7 days of one mushy item a day and Protein Drinks and then progressively move up to real foods.

after seeing this, i would DEFINATELY call your doctors office. it doesn't hurt to ask.

hellllooo... i've been banded for 5 days now.. and each day gets better. day 1 really isn't bad. you'll definately want some sugar free popsicles with you for your throat. day 2 is also just a lot of grogginess. you'll want to rest but make sure you are walking around AND getting Protein in your body, via Protein Shakes. protein is what's going to help you heal. day 3 was the worst for me. i decided to stop taking pain meds because you don't want your body to get accustomed to them. i'm taking tylenol instead. by now, you want to be drinking your Protein Drinks in full swing, along with the Soup and crystal light. just make sure your walking around.. it'll will get the gas pains moving around. i told my work i'd be going back 5 days later but that definately wasn't long enough. i extended it to 7. just make sure you KNOW you're ready. as far as the port, i really don't feel it yet. i'm still very swollen around my belly and cant get much down. but from what i've heard, even after you lose the weight, the port becomes unnoticeable.

gooood luck with your surgery... hope i've answered a few questions for ya!

thank you everyone for the well wishes! i'm really happy i have made this decision... despite the pain. haha. well.. i'm feeling a little better. walking definately helps. but i'm still very swollen and can't eat much. hopefully that will pass in a few days. how is everyone else doing?

heyy guys. i was also banded on april 3rd, and the gas pain is getting better. it was really bad the first two days but walking around and gas x has helped alot! even try taking deep breaths.. it hurts but it will move the gas pain around so its not just hovering around your belly. im having more trouble with trying to get anything down. it feels like EVERYTHING.. meds, shakes and soup.. gets stuck in my chest. its weird.. im going to call my dr. in the morning. hope your gas pain goes away soon!