kfgates

I knew about the 6 month PSWLP so I started last month with my PCP. I am just hoping he is making his notes to meet Cigna's criteria. I have not sent off my paperwork as of yet. I just have my first consult with the surgeon on Tuesday, but I NEED to prepare to put my mind at ease. The one thing holding me back is my low BMI. I certainly have the co-mobidities ie: Gerd, Stress incontinence, fallen arches (I even had surgery on one foot already) high cholesterol, elevated blood pressure, herniated discs in my back, and severe joint pain in my knees. I just don't know if this will be enough for Cigna...it will be the only thing holding me back. Getting ready for an appeal is probably a self fulfilling proficy, but at least I will be ready. Thanks again. Kimberly

where do you have your fills if you have your band placed in Mexico?? Who do you go to for follow up appts??

I am setting myself up for denial as well...I am so sorry you were denied, but as other people have said....appeal appeal appeal. I haven't even submitted to the insurance co yet, but I am also preparing for an appeal so I will be ready. I have Cigna and many of the same co-mobities as you...ie: fallen arches (I have even had surgery on one foot...I would NOT recommend it) Gerd, herniated discs in my back (that I have an MRI for) severe knee and joint pain, high cholesterol, elevated blood pressure and stress incontinence. My problem is my BMI is low at this time from dieting...I just know I am the queen of yo yoing and it is already starting to come back. (gee and i thought i left it on the highway....lol) Please do not give up and trust me it is easy for me to say, but since I have put all my eggs in the "lap band" basket I will feel just like you.....God Bless Kimberly

When you say said it off "again" did you get denied the first time?? Did you have to appeal to your insurance company?? I am preparing myself for a denial so I am doing all I can to get ready for an appeal.....what did you do different the second time that you did not do the first?? Thanks for any help you can offer. Kimberly

Wickedme, are you going to Augusta or Portland?? I have my first consult with a surgeon in Augusta on Tuesday...Kimberly

Hi Erika, I too have a low BMI and somewhat similar co-mobities Gerd, herniated discs in my back (with an MRI to back it up) terrible joint pain in my knees, elevated blood pressure, high cholesterol, stress incontinence, and fallen arches. I have been trying to dot my i's and cross my t's in preparation for my first surgical consult. I was thrilled to read your post...one woman wrote to me saying to stop....she too has Cigna and was denied with similar issues. My OBGYN is writing a letter as well as the podiatrist that tried to treat my fallen arches. I have also started a PSWLP with my PCP just in case the insurance company requests it. Do you have any suggestions as to what else I can do. Thank you for posting....Kimberly

Hi Pam, I too am in the beginning stages of the band procedure. I have already attended the seminar and have an appointment with the surgeon on Tuesday. I found the more I learned the better I felt...I was a paralegal for years, so the research part of this was exciting for me. I started by downloading the criteria that my insurance company requires. Once I felt I was a candidate I started researching the band. It may sound silly, but the book "idiots guide to weight loss surgery" was very helpful. My BMI is low (according to insurance standards) but I have herniated discs in my back, stress incontinence, high cholesterol, elevated blood pressure, Gerd and painful knee joints. I have been getting ready for the surgeon...My PCP has already forwarded the referral, he has also written a separate letter to the insurance co. I also have letters from my OBGYN and the podiatrist that tried to fix my fallen arches. My goal is to present my insurance company with so much information they approve the procedure. Again the research part has been rewarding for me, so if there is anything I can do to help let me know. Kimberly

I live on the East coast and work in a restaurant...I have never seen one of these cards...but I am sure they would come in handy....Kimberly

Mtanna, Thank you so much for the encouraging words...I really needed them. I have 3 docs that are writing me letters (obgyn, podiatrist, PCP) The PCP wrote the letter a month a go and it was wonderful. Now Cigna is requiring 24 months of history, so I have my appt with him tomorrow to see if he will research back 24 months. I have yo yod so much that I am sure there will be a month or two that I was below 35 BMI....not sure. I received a response from someone that went thru everything with Cigna and was denied...she had the same BMI and similar co-mobidities....I know everyone is different...I just pray Cigna sees that this is my only chance of having a long life with my young children. Congrats on your approval....I am sure all the hard work will be worth it. Sept 10th will be here faster than you can imagine. Have you had all of your pre visits?? Nutritionist, Trainer etc? Kimberly

I contacted Cigna first. Yes they do pay for it, but like most there are criteria. BMI of 40, or BMI of 35 with a co-mobidity. Without Insurance I would not be able to have the procedure....I have two small children and just could not bring myself to spend that kind of money on myself. I can't even imagine how much something like this would cost...and Mexico is out of the question...lol. Kimberly

I have Cigna and am willing to dot my i's and cross my t's, but could use some help. My BMI is low (low according to insurance..lol) I do have co-mobidities ie: herniated discs in my lower back, Gerd, Stress incontinence and knee and joint pain. I am afraid I am setting myself up for disappointment. I know I am the perfect candidate for this procedure (as does my PCP) but want to be prepared for submitting to Cigna. Anyone out there submit to Cigna with low BMI?? I have already begun my 6 month diet with my PCP just in case. Thank you in advance for any help you can offer. Kimberly

Right now it is 36.8 and I am fighting to keep it there. I am hardwired to diet and summer is usually when I drop lbs and pack it back on in the winter. If only I had a BMI of 40! I have contacted 2 other docs for letters regarding Stress incontinence and plantar fasiitis. I am setting myself up for an appeal already. I am from Maine and have my first appt with WLS doc on the 29th. Thanks for your help...what were your co-morbidities?? Kimberly

Hi Nurse Cathy, I am just starting out on my long journey. My initial appointment with the surgeon is next Tuesday...You seem to be the "go to girl"...lol. I have Cigna and have read and re-read all the information on bariatric surgery Cigna has to offer. My BMI is low, it ranges from 35-37. I do have some co-mobidities...herniated discs in my lower back, Gerd, joint pain, fallen arches, stress incontinence and I am awaiting my cholesterol blood work (it has been high in the past). My PCP feels I am a perfect candidate for the lap band and has written a wonderful referral letter to the surgeon (he also forwarded it to cigna) Right now I am working on getting other letters from other doctors regarding my incontinence from my obgyn, and a letter from my pedicurist for my fallen arches...do you have any advice. I live in Maine...when we submit to Cigna is there just one central place that the information goes?? Once again I am just starting out, but I have done a great deal of research and want to be ready, Thank you in advance for any help you can offer....Kimberly

mtanna, Have you been approved?? I am just now starting my long journey...I am willing to dot the i's and cross the t's, but could use any advice you may have. My BMI is low but i do have co-mobidities...ie: herniated discs in my lower back, gerd, stress incontinence, joint problems and I am waiting for cholesterol bloodwork (it has been high in the past). I have found Cigna to be helpful in the past, but after reading these posts am really concerned. Thank you in advance for any help you can offer. Kimberly

Sister, Why did Cigna deny you?? I am starting out on this long journey and have tried everything (as did everyone on this site) to lose..I feel I am a perfect candidate for this procedure (as does my PCP) but my BMI is low. I do have herniated discs in my lower back, Gerd, Stress incontinence and joint problems... I am just concerned this is not going to be enough. I am working on getting any letters I can get from Dr.s that are not my PCP. I am so afraid I have put all my eggs in this basket and after all this if i get denied i will be devastated.

Suzanne, I was reading thru this thread...I am trying to get my ducks in a row and noticed you were willing to share your letters. I have a low BMI but do have co-mobitieies ie: herniated discs, stress incontinence, plantar faciatis (fallen arches) and Gerd. I like the idea of getting letters from other docs...ie obgyn etc...would you be willing to share your letters with me?? Thank you in advance for any help you can offer. Kimberly

Are you saying you are have to do 12 months of supervised dieting?? Why so much?? When will they submit to insurance?? Kimberly

You are right about the by pass...but looking around the room it seemed that most of them would not quality for the band anyway...he said you could not get the band with a bmi of 60. I figured if you were there you would come out of the woodwork...lol... I am sooooo ready for this that over hell or high water I would have gone. As for getting in with the pshy dr. and the nutritionist that is a definite. I am hoping that when I have my initial consultation with Trieu I am will be able to tell him I have already begun my 6 month diet and he will let me proceed with the other appointments. I will post a question about that...thanks. If my timing is right I am looking at a November/December band (that's right I will get one more Thanksgiving/Christmas). I am a teacher and would just love it if I could have it done before the holiday break...I wouldn't have to take any extra time off. You missed quite the meeting...lol...one woman even told everyone that voices were talking to her...God forgive me, but I turned to my friend and said...gee if only those voices would stop telling her to buy oreos she would be all set....Do you have any idea when they will make a new forum...DECEMBER BANDSTERS?? Thanks again Sarah! Kimberly

Hi Sarah, I attended the info session on Thursday and because I had researched so much and you were so kind to answer questions I really did not learn anything new. I was pretty thrown back by the people there and the questions they asked. Dr Truie (sp) was wonderful and I asked Laurie if I could use him. My PCP mailed my referral to Mckee but I just loved his sense of humor. He reminded people that questions were fine, but that it is not recommended that people share health issues....I know way too much about people that I just met....yuck! I have Cigna and according to their info Cigna requires a 6 month diet...I already have 1 month under my belt, and if they take my PCP's recommendation than i will not need it...I will just plug away just in case. I so appreciate your time, I promise I will try to find someone that is close to my date. Kimberly

Hi Susan, Thank you for sharing...I am concerned about "slippage". It is nice to know it is not devastating and it can correct itself. When you say you were constantly PBing was it more than once a day?? Were you able to get anything down? Did it overfill because you didn't have any restriction so you asked for more? Sorry for all the questions, but know the answers are much appreciated!! Kimberly

Harvest...I can't tell you how much i LOVE Wii Fit...I actually look forward to getting up in the morning and doing my Yoga and aerobics! It is an expensive venture, but it was worth it. The hardest thing about the Wii Fit is finding one....lol Good luck Kimberly

Mary Jo, Did you choose Mexico because you are a self pay? I live in Maine, so Mexico is a little out of our way...lol. If Insurance does not pay for my procedure I am going to have to bow out. Where will you have your fills?? I wish you all the best and enjoy your stay in Mexico..Kimberly

Newlife, Did they say whey they thought your band slipped?? I certainly understand why you are looking for non surgical options...I can only imagine the cost of going back in. Please keep us posted...It means a lot to have you share your experience. Kimberly We will keep you in our prayers!!

Allana, Did you have a long wait to get in to see a doc in Portland? I have heard the wait is from 1-2 years. How are things going for you so far. I am going to the info meeting in Augusta on Thursday so I am just starting out on this long road. Kimberly

Hi Angel, I am going to the info session in Augusta on the 17th. I too am just starting out, but am anxious to see what they can tell me that I have not already researched. I live in Bath and have a 45 minute travel, but have been told that Augusta has been doing these longer than Portland, so that is why I chose them. I don't have as long to travel as you, but I am hoping I can schedule as many things on the same day as possible ie: Nutritionist, Trainer etc. This web site is just wonderful and I have met some wonderful people. Kimberly