Chunkymonkys

Sorry to hear about your policy :thumbs_up: I have worked in the insurance field for a long time (BC being one of them) and when you have an exclusion on your policy, there is no way getting around it. Applealing does no good. Once it is written into your policy, that's that sadly. Your best bet is to go to your employeer benefit person (you know, the one that no one really knows but writes up the policies) and ask them if they are going to consider covering it in the future. It will probably be futile, but what do you have to loose right? I ended up changing jobs to get mine covered lol.

Sorry to be the bearer of bad news, but I didn't want you to have to go thru a bunch of hoops to only be crushed at the end of a long drawn out battle.

Good luck!

Yeah, Ponce was my first pick but my insurance doesn't cover him. Go figure!!

I had Ponce too and he wasn't listed on my insurance as being in network, but turns out he is. Guess he is shy lol. You can always try Dr Frohm or Dr Paynter. I have met both and both are very great. They know their stuff!

I had a friend I used to work with that went all the way to Nashville to use Dr. Rutlidge but that was for the bypass. I think that is all he does...

Check out www.gastricbandinstitute.com they are pretty great!

Good luck!:thumbup:

Scratching relieves it lol

I was banded 5/29 and omg my stomach STILL itches something fierce! I've drawn blood on a few stretchmarks lol. Nothing helps though....

nothing but a nice set of fingernails :redface:

lol

I'm right there with everyone too! I was banded 5/29 and go in for my first fill on the 26th. I can't wait! Right now, i'm eating whatever and whenever I want and I swear, once I got off the liquids it was like a switch was turned on and BOOM, I'm hungry! lol I get full off of a little less food, not much, but usually just in the morning. In the evening I can eat as much as I used to, which sucks but then I'm hungry 2 hours later. I dont know what's up with that. Like everyone else I can't wait to get my 1st fill...hopefully that will nip this in the bud!

Good luck everyone!!

I was banded last thursday by dr Ponce. I've had a few bumps in the road of recovery, but in general had a great experience at Memorial for the surgery.

I'm just over a week out and really starting to feel better. I can't wait to get back in the swing of things.:tongue2:

Hey, we had our surgery on the same day, same hospital, same suregon. How cool is that? Congrats on feeling better!:thumbup: Small world!

I felt icky in the tummy after mine too...kinda sluggish, not overely nauseaus (sp) but yet not quite right either lol. It will go away, I felt fine the next day so don't worry too much, it will pass!

I'm a Bandster!! :biggrin2: Surgery was 3 hours, w/ hernia repair. The first night was in the hospital, and at home I slept nonstop for the next three days. Thanks to the Percocet. The pain feels like puncture wounds. I mean surface pain, nothing real deep. I did have the GAS, enough to clear a room :thumbup:. I know TMI, but so far I've only had some left shoulder discomfort. The Clear Liquids made me very weak. Lack of sugar, according to the surgeon. Once I had my first Protein Shake on day 7, I started feeling better.

When did you all start mushies? According to my doctor, he wants me on Protein Shakes until my first fill, June 30th. I know I need to heal, but 5 weeks? Doesn't that seem excessive? If I count the two weeks prior to surgery, that's 7 weeks of liquids! I'm already dreaming of scrambled eggs and runny oatmeal!! :thumbup:

Wow, 7 weeks of liquids? ? I feel your pain! Poor thing! the Protein shakes until your 1st fill does seem excessive. I mean, how are they going to know how much to fill you if you can't tell them accuratley how to gauge your hunger? I was banded on 5/29 and they told me 1 week of clear, 1 week of full liquids then 3rd week is soft foods then 4th week, which is when my fill will be, i'm up to whatever I want (well, the new guidelines anyway...no hamburger Buns for me *sigh* hehe)

Good Luck!!!:tongue2:

Congrats on your NSV!! I know this is something my partner and I are looking forward to doing once we get some of the weight off...Guess we will find out who is more of a chicken, ha!!

They do cover the surgery. i also have two co-morbidities does that change the 6 month requirement?

no, you still have to go thru the 6 month supervised either way unfortunatly!

its a long process but worth it in the end

Welcome! I would call the member service # on your CIGNA insurance card and tell them what you are wanting, and see if they can find out the requirements. I work for CIGNA, and every policy is different, but, most of them want a 6 month supervised diet, 5 years of weight loss history as well as a referral from your primary doctor stating that this surgery is medically necessary.

I started out by checking my benefits to make sure that it was not an exclusion on your policy (if it happens to be, then you dont even have to bother with insurance, they wont cover it no matter what) then I made an appointment with my family doctor and told him what I wanted and he made the referral to my surgeon and they worked with me at their office in regards to insurance.

Good luck!!

Thanks! My insurance (Cigna) required me to have those classes before they would approve the surgery, so I have already paid the $95 for the classes. So hopefully I wouldn't have to pay the hospital anymore. Johnna at Dr Paynter's office told me I have to pay my coinsurance to their office, so that's great if I don't have to pay the hospital anything extra.

I have, and work for CIGNA and I am having my surgery done by Dr. Ponce on this Thursday the 8th!! I went thru the same office you did, I have been working with Johnna and she is so very nice! I had to pay my $ up front to them, and they take care of where it needs to be shipped out to, etc. The only other thing I've had to pay for other than that, is the $95 fee to Memorial for the pysch and the nutrition class. Johnna assured me that there shouldn't be any more charges, but, well, we will see LOL.

Good luck!!

Did I scare everyone away?? :huh2: Hey, I just started here! Did the thread move? I like to read how everyone is doing. Or how about some newbies, like me? We know your watching..

..OK, I see the surgeon Friday. To go over my EDG, blood work and other tests. Monday is the Nutrition Class. Tuesday I have the Psych Eval. Looks like I'll be busy, busy! Can anyone tell me about the Psych Eval? When I called they said it was 100 Q&A. How much can they really learn about me from a test? That I'm not loopy! :eek: What if I am.. just a little bit. I mean, aren't we all? :tongue:

The Pysch eval for me was brutal LOL. It really is just a Q&A session. They ask you about everything, i was suprised by all the questions! They ask you about your parent, sibilings, grandparents, friends, the works. It really isn't all that bad. I figured I would be in there for like 20 minutes...it turned into 50:eek:

The nutrition classes are way cool though so no worries!

Congratulations! :w00t:

This is terrific! I am so glad to have a group of GLBT supporters. I am just starting the process and am in month 2 of the 6 month waiting period-ugh! I have CIGNA and I know they are really hard to deal with, so I am doing all I can to keep in their guidelines. My BMI is 36 so I am treading the thin line of following their rules, but not dropping too much weight before the surgery so I disqualify. My partner and I are both going to be banded and I know this will pose its own special challenges, but I hope we can motivate each other. Anyone else deal with CIGNA? What responses have you had from friends? I am trying to decide what ( if anything) to tell people. The eating out thing with others is what I am worrying about already. Let me hear from you!:w00t:

I have and work for CIGNA and mine went really smoothly and fast. I was pleasantly suprised. I am quite a bit bigger than you, so i didn't have to worry much about loosing too much weight :eek: but my dr's office let me 'flub' the 6 month waiting. All I did was fill out these papers that the office gave me and put in what they needed in a timeline and submitted it along with all the other junk they require and i was approved in 4 days...Now i dont know if that is the norm, but i think it helped that i went thru a bariatic group to set up my stuff rather than my regular PCP...all he did was get the letter of medical necessity.

I know CIGNA will cover it, it just depends if you meet their qualifications as well as they want you too. My advice is to stick to your program and keep tabs of EVERYTHING and, if you have to make a little adjustment here and there, they wont know.

Listen to me being all sneaky! haha dont tell!! :huh2:

You can try mixing them in orange sherbert...my friend does that, it seems to work well for her

I work for CIGNA and have their insurance and honestly, I wouldn't worry about it. You've got enough going on to warrant the surgery, and they dont check up on your weight loss attempts. They just need to see it in writing. If it comes back with a denial, then I would tell your PCP about the medical condition mistake and appeal it.

You can always call the number on the back of your card and ask to talk to the prior auth department and check the status of your case. Once they receive it, they should have an answer within 5-7 days, so the wait, as long as those days can be (trust me lol) will go by faster than you know it!!

Good luck!!