AliciaA122

I have Cigna too. My requirements were all done last week but my surgeon's office has yet to submit my package to them. I'm still waiting. Hopefully you'll get an approval soon!

So, all my requirements are done and everyone has submitted their stuff to the surgeon's office. But, doesn't look like the surgeon's office has submitted anything to insurance yet. As of Wednesday last week they had everything and told me they'd call if they didn't. I hate being a pest, but I want some answers. No one over there seems like they want to actually talk to me about the process. Just keep saying, we'll call you when you're approved or denied. Ok, thanks, but why can't we talk this through so I have a better understanding of time and process? Frustrated with the communication for sure! I'll just keep calling and checking every few days. Also not sure why the receptionist will never actually put me through to their insurance specialist.

I talked to my surgeon's office today and was told they received the notes/referral from my PCP this morning. After doing a cursory glance she said it looked like they had everything they needed. My surgeon just needs to review my PCP's reports and then everything will be submitted to Cigna. Ugh. I'm so nervous. I hate waiting.

Still, you're approved! So that's a major relief at least!

wish I'd seen that in May! I heard about it being changed but couldn't find the official policy at the time. Would have saved me two months of visits!

Oh yikes! I have Cigna. This is scaring me. Had my last of my 6 month doctor's visit's today and have done the nutritionist and psych evals. Hopefully my surgeon's office will be able to submit everything this week or next. I'll stay on them and Cigna!

I have Cigna too and I've also heard the 3 month thing. I know there is a 3 month multi-disciplanry diet you can do (or used to be able to do) that's more intense than a 6 month PCP diet. I had my last PCP appointment today in my 6 month diet. I have done all the other requirements, so now it's on to Cigna for approval... well, after my PCP writes his report and notes. Fingers crossed for you Emily! Update us on how it turns out.

I'll tell you that there is a wide range of what the psych evals entail. Mine was not about behavior modification, well, there was a little of that, maybe 5 minutes. Mine was more about my life history, trauma, weight issues, a little bit of everything. I have heard where others have to take tests. Others get asked strange questions. So, it could be anything!

Wow! That stinks. If you don't mind me asking, why do you assume you'll be denied?

I'm way late to this, but thought I'd throw in my opinion and experience. My husband and I tried to conceive for a couple of years on our own with no success. We went to a fertility specialist and began testing. At the same time I began looking into Lap Band. My fertility specialist AND primary doctor both told me to try to get pregnant first and then pursue WLS. I was 31 when I began fertility treatments. However, my fertility specialist told me that by having the surgery I would be taking another large chunk out of my fertile years. He could find no reason that my weight was affecting my fertility and as it was we were undiagnosed. We began treatments including Clomid, injectable meds and IUIs. We conceived our daughter on an 'off cycle' after an IUI cycle. She's 14 months old and I'm now very close to having my sleeve surgery. SO GLAD I listened to my doctors. Also, to the previous poster who commented that you can just adopt and that there are so many babies who need homes. If only it were that easy. Adoption is painfully slow, definitely not a guarantee and very expensive. You can't 'just adopt.'

I had my final appointment in my 6 month doctor supervised diet today. My weight was up from last time. Yuck. He said that shouldn't matter though. The entire 6 months it's been up and down. Now he submits his notes and report to Dr. Elliott's group and then they package everything up for the insurance company. Getting more excited and nervous now as it all seems much more real.

RDO- I have a question, if you see this. The manometry and 24 hr pH test, are those requirements for your insurance or Dr. Elliott? I haven't heard anything about them.

Hi all! I'm in Powhatan too and see Dr. Elliott. Haven't had surgery yet but am hoping I will next month or September. I have seen the nutritionist and had my psych eval. I have my last doctor's visit in my 6 month doctor supervised weight loss plan on Tuesday! After that all of my information can be sent to my insurance company for approval. Fingers crossed! I haven't been told about any other testing or other requirements, so I'm guessing that will happen after approval.

If you don't mind me asking, why were you denied 6 times? Was it a lack of documented weight history?

Good luck! I have Aetna too and am just starting the process. I just met with the surgeon yesterday and have to decide if I want to do the 6 month doctor supervised diet or the 3 month multi-disciplinary program. If I do the 6 I figure I’d be banded late October/ or November. I can’t decide which to do… so I’m calling the place that runs the 3 month program today for further details. I'm leaning toward the 3month because it would mean being banded sooner and that's a good thing. But we'll see.

Wow Larry! That's phenomenal. 102 pounds in 5 months?! Good for you!

I haven’t had the surgery, but your weight loss sounds very good to me… and normal or above normal, I’d assume. The goal they gave us at my seminar is to lose 1-2 pounds a week and you’ve lost 4.5 pounds a week!

Thank you so much! Your post is chock full of very good information. I really appreciate you taking the time to share it with me. I am hopeful that if my weight is what’s preventing us from conceiving then this surgery will help us.

Hi! A little about me. I am Alicia, 30 years old, from central Virginia, married to a great guy who is very supportive and loving. I am just at the very beginning of this process. I have attended a seminar, done a lot of reading and lurking here, and have an appointment with the surgeon a week from tomorrow. My insurance has the WLS rider. I am currently around 310. :biggrin: I need to lose a lot of weight, 150+ to be at a normal weight. But, my own personal goal is to be at the 200 mark. I have a number of motivating factors, but the biggest one is to start a family. My husband and I have been trying to conceive (off and on with breaks) for about 2 years. I have an appointment with a fertility specialist in June to find out exactly what is going on with me, though I’m pretty convinced I have PCOS due to all my symptoms. My PCP says I should try to have a baby before WLS, but I want to pursue both concurrently and see where it leads. I know I will have to do a 3-6 month supervised program for insurance purposes, so that will allow me to meet with the fertility specialist and get his opinion. I’ve probably shared too much. But, that’s me. I look forward to this journey and am excited at the prospect of shedding the pounds.

Congrats to you, K! 20 pounds is still...20 pounds gone and closer to your goal. That must feel good!

I too enjoy a beer every now and then and have 2 diet pepsis a day! I know I’ll have to give them up if/when I am banded. But, I’m willing to do it for the sake of my health. J My hubby suggested I could just let them get flat before drinking…hah!

I’ve been wondering about this myself. There is some good info (and opinions) in the Realize band forum. You may want to check that out. I plan on deferring to my surgeon, when I eventually and hopefully get to that point. But, from what I heard them say at the seminar it’s based on patient opinion… they’ll give you what you ask for. So, I don’t know!

I am just at the beginning of the lap band journey. I have been to a seminar, done some research, and am meeting with a surgeon next week. However, I had my a-ha moment last month. I am only 30 but have a strong family history of pre-menopausal breast cancer so my ob/gyn ordered a mammogram. I had the mammogram and a ‘suspicious mass’ was found in my left breast. I had a spot compression mammogram and an ultrasound and the doctors felt the mass was not cancerous but said I could get a breast MRI just to be certain, for my own peace of mind. When I was scheduling my MRI they asked how tall I was (5’6”) and how much I weighed (about 310.) The scheduler got very quiet. She then said she’d have to check with the MRI techs and get back in touch with me. They determined I should come in and do a dry-run with the machine. I go in to do that, lay on the very uncomfortable table and she starts the machine. I didn’t fit. I got stuck at the butt. I was mortified and so sad. The breast MRI IS a little different from the regular, they put you up on a board that raises you up a few inches, but still… I wouldn’t fit. So, that was my moment when I KNEW I had to do something.

Thank you both so much! I couldn't find the bariatric info on Aetna's site anywhere. :tongue_smilie: I didn't look hard enough I guess. Thanks again!

I have an appointment with a surgeon in a week and a half. I have Aetna and have verified that I have the WLS rider. However, I have a question about the co-morbidity requirement. For the past 5+ years my bloodwork has indicated high cholesterol and elevated sugar levels, but I am not on any medication for those conditions. In fact on my last fasting bloodwork my glucose level was 129, which in doing some research appears to be in the diabetic range. My PCP has never recommended anything but diet changes, perhaps because of my age (30.) I also routinely have high blood pressure when I go to the doctor's office. Do you have to have a history of having your co-morbidities treated? Know what I mean? I worry that even though my medical history shows years of weight-related problems none of them have been treated with medication and that could be a problem. A little about me: 30 yo female, 5'6", 310 lbs.