Shelby

Hang in there Sooverit! It's all just so frustrating, isn't it? I believe Cigna's knee jerk reaction is to decline immediately but never give up!

Claramae I'm so glad you are doing much better!

When did the 2 of you get banded? I'm having awful port pain since surgery 8/28 and sitting/standing is so painful. I can't even think of bending over - I'm seeing stars just standing. I didn't think I'd still be in this much port pain.

Because my surgeon had an emergency earlier in the day everything was delayed. I didn't go into surgery until 6:30pm. I was concerned about his energy level... did he have dinner, did he have time to rest... told him I didn't want a shaky, cranky doctor working on me... he laughed and reassured me he was rested and full. Everything turned out fine - I'm so grateful.

My case is with the National Appeals Unit (I have Cigna) and Walter & Kelley Lindstrom have been helping me with this. Kelley is anticipating a denial (based on her experiences). The next step would be an Appeal Hearing. Has anyone gone this far in the appeal process? I know I would have to attend but not sure what to expect. The Lindstroms will advise me but since they are in CA and I live in TX I'll be attending this alone. Has anyone attended one of these?

I have a date! Tues, Aug 28th with Dr. Cribbins at Presby Plano. mbsbike2002 - I feel so much better after reading your posts! I'm so glad everything is going well for you.

I'll be banded on the 28th with no pre-op diet requirements. I enjoy protein drinks so I'm planning on drinking more of my meals for the next couple of weeks. I want to avoid the fatty liver too. Then onto post-op diet...

Congratulations!!! I got my date too -- Aug 28th!

Shelby - August 28th

I live in Texas too! Just got a date -- Aug 28th with Dr. Cribbins! I'm excited and scared at the same time.

Hi Bigez1, my policy does covers WLS so my battle will be different from yours. Cigna just kept saying no and I was forced to appeal. From what I read here on this site - winning an appeal when there is no WLS coverage/rider is not too hopeful. But keep reading these posts - I know I have read someone recommending what one can do in this case. I'll see if I can find them.... Good Luck!

Cindy - this is great news!! Congratulations on all your testings! I'm sure it's such a relief that it's over. Sept 12 - fantastic! I have good news too - I've been approved!!! Cigna's legal counsel called my atty to say I was approved. Legal never calls on approval - we're assuming they received my paperwork the first time she sent it and they have 30 business days legally to approve/deny - at that point it was over 60. I'm just happy I'm approved. Right now I'm waiting on a call back from my doctors office - need to schedule the pre-op testing. What type of pre-op tests did you have to complete? Congratulations again!

Thanks Big Fred and Sweethot143! I'm still so excited! Big Fred hang in there - my advice to you (I know you didn't ask but from my experiences) regarding your 6 month PCP visits - make sure your doctor documents your weight and discussion re diet and exercise. Cigna does comb thru these notes. Oh and never give up! Thanks again and best of luck to the both of you!

I work with alot of people and only 2 friends at work know of my journey and are very supportive. I will tell my boss I'm having a procedure but will not tell him the details (legally he can't ask). And I will tell everyone else that I'm taking vacation and ask for his support in telling folks I'm on vacation if asked. When my band and I have some time to get better acquaited I'm sure I'll be happy to share my story. But for now - this works for me.

I will also be banded by Dr. Cribbins. I was recently approved so I don't have a date yet but hoping it will be in the next few weeks. Good Luck to you! Keep us posted!

I don't have a date yet - have just been approved! I'm assuming it will be sometime in September. I'm so excited!

Thank you Cindy! I can't tell you how much better I feel after reading your post. Kelley is great and she is hopeful about getting an appoval at the appeal hearing. I'm so happy for you! Continue with your pre-op testing! You can do this! Let us know when you have a date - best of luck to you!

I found out yesterday that the Appeal Hearing will be via phone and my attorney will be on the call with me! Big whew!

I totally understand Heyhon63 but there is really no getting around the 6 month supervised PCP visits with Cigna. It will be done before you know it. Just make sure your PCP writes down your weight each month and notes regarding your diet & exercise discussions. Good Luck to you!

This is a great place to ask questions! My first denial was because the surgeons office submitted my paperwork before I completed all of Cigna's requirements (yup!). So that was a no-brainer denial. I was denied the 2nd time for the Gastric ByPass surgery - yeah - scrary huh? When I called Cigna regarding this they said I should not have followed the instructions on the 1st deniel letter and included the letter. Who knew? Then I found a new surgeon and they submitted everything to Cigna (w/o denial letters) but was denied because of something to do with my 6 month doc visits. I say 'something' because I received a 2 page letter that I just could not understand! Seriously - when I called Cigna they couldn't explain it to me either! And that time I actually talked to 4 people and no one could explain it! They suggested my surgeron and their Director of Medicine talk about my case. My surgeon called 4 times before he gave up. He was never able to reach the Director of Medicine. He was told he was given the wrong number to call, was put on hold for 20 mins at a time, etc. I was then referred to Walter Lindstrom who accepted my case and I'm now waiting for him to submitt an appeal. Sorry so long winded - it's just so frustrating when it all seems to be administrative issues. I meet the criteria, I've completed what was required by Cigna, my policy covers Lapband (no exclusions). It's just crazy! Guess Cigna is hoping I'll go away but I'm not! Hang in there! Keep calling. If you get a rep that is not so helpful - hang up and call back. I was only told the reason of denial after the denial letter had been mailed to me. Guess that way I'd have to re-submit and wait an additional 30 business days. Just my guess. I hope I didn't scare or discourage you! Keep the faith! What's meant for us won't go by us!

For me Cigna took the full 30 'business days' to deny me. Call and call again and again. Only twice was I able to get past the first line of customer service reps (and I've been denied 3 times). There are some reps that will help you - others are just reading the notes from the screen in front of them. Keep calling! Good Luck!

Has anyone had to do this?? Cigna Authorization Dept wants to have a Peer to Peer phone conversation with my surgeon so they can discuss what additional information needs to be provided by my surgeon or myself. Quick recap: I was denied a few wks ago because of 6 month doc visits which was completed and submitted. I called Cigna to find out exactly what was missing and after talking to 4 people (on the phone 1 hr 50 mins) they told me I submitted everything and it's all documented. Not sure if this is normal request or if they just didn't have an answer for me so and this request would get me off the phone. Although the folks I was talking to today were wonderful! Finally - someone who actually was trying to answer my questions.

Glad you are back and everything went smoothly!! Congratulations!

My surgeon is Dr. Cribbins in Plano. He's great and I really like his coordinator Sheryl - she's been fighting for me; keeps me updated; always returns my calls. She's been wonderful. I'll say a prayer for you on April 4th! Get back on this site as soon as you can after the surgery and let us know how you are doing!

Congratulations Wanabethin!!! I'm very excited for you! Do you have a surgery date yet? Who is your surgeron? My Update: Cigna gave my surgeron the run-around and they never connected via phone. The office referred me to Walter Lindstrom (ObesityHelp.com Atty) and he has accepted my case! Walter will submitt the paperwork for an appeal. He doesn't take any cases he can't win so hopefully he'll be able to help me! I'm so grateful for his help.