CSinTX

Hi CJett - Was there anything difficult when it came to dealing with Cigna? I started this process in February and should be able to submit my paperwork in August. I too am with Cigna (open access). What months did you do the diet thing? Cathy

Hi Shanese01, Your policy with CIGNA sounds a lot like mine. My CIGNA covers 90% but I have an out-of-pocket max of $1000. So no matter what the hospital comes in at my max out of pocket for the entire year is only $1000. May want to check your insurance policy and see what your max is. Just a thought. Cathy

I am trying to decipher this portion of Cigna's policy. The first paragraph mentions the 6 month diet within last 2 years. The second paragraph mentions 6 month participation in weight management program within the last 5 years. Are they giving us 2 ways to meet the diet qualification? Thanks for your time. Cathy Failure of medical management including evidence of active participation within the last two years in a weight-management program that is supervised either by a physician or a registered dietician for a minimum of six months without significant gaps. The weight-management program must include monthly documentation of ALL of the following components: weight current dietary program physical activity (e.g., exercise program) Programs such as Weight Watchers®, Jenny Craig® and Optifast® are acceptable alternatives if done in conjunction with the supervision of a physician or registered dietician and detailed documentation of participation is available for review. For individuals with long-standing, morbid obesity, participation in a program within the last five years is sufficient if reasonable attendance in the weight-management program over an extended period of time of at least six months can be demonstrated. However, physician-supervised programs consisting exclusively of pharmacological management are not sufficient to meet this requirement.

Hi Kathy, I am so excited to hear that you'll be submitting your paperwork soon and hopefully you'll get your approval by the end of the month. I go for my 2nd dietician appointment on Monday and plan to sit down with my insurance coordinator to see exactly what my PCP sent her. Keep us updated on your progress and again congratulations. Cathy

Hi Kathy, I just noticed you are from Iowa. I live in Texas but my daughter goes to ISU in Ames. Good luck tomorrow and let me know what you find out. Cathy

Hi Kathy, I am under the impression that your PCP would need to include in his notes what was discussed on those monthly visits. Such as what type of exercise you plan were doing or planning on doing and what diet you did or will be doing. Atkins, Weight Watchers, South Beach or reduced calorie, etc. I have over 20 doctor visits spread out over the past 5 years with those exact discussions but none 6 months consecutive and most of them are older than 2 years. Because my BMI was not over 40 for any consecutive visit I plan to do the 6 month diet thing and then submit. After reading other posts it sounds like you get just a couple of changes to appeal if you get denied and I don't want to take any changes. Have you asked the insurance person at your WLS clinic that question? I asked mine and she said we can submit but she did not think it would be approved. Besides it only cost me $15 each month so that is not a factor. Patience is not one of my virtues, but I'm working on it. I over analyze everything as well, so we'll be a great team. Cathy

Was it because Cigna required her to have 6 consecutive months that it took her 10 months? Cathy

I kinda gathered that as well since they said "morbid obesity" but they don't define what they consider morbid obesity BMI to be. I am 1 month into my 6 month diet. Lets keep in touch since we are at the same time with the same insurance program. I go for my second weigh in on Monday the 22th. On my first visit they ran every test possible and Cigna covered everything 90%. So far Cigna been great. Cathy

Hi Alison, It's been a while since you posted this - but how did it go with Cigna? Thanks, Cathy

Dana36 Were your 6 months of weigh ins consecutive? Thanks, Cathy

Hello everyone, I have my first appointment with a therapist (psychologist, psycho) this coming week and we all have bad experiences in our past. I have no mental issues but did survive my parents going through a nasty divorce in which I ended up living with grandparents instead. I do work in a stressful situation (but have a job thankfully), I'm over weight and have only 1 child who is in college in IA (17 hours drive from us). Yes, there are times I am down. I have read other threads about how others said things that hurt them in the evaluation, brought up bad feelings from the past, did not get a Good To Go clearance and caused them to return for a second visit. I have also read in other threads about people saying what the psycho wanted to hear even though it was not quite the truth. I want to get a "Good To Go" letter from the first visit. What do I need to avoid in saying and what do they want to hear? Any help would be greatly appreciated. Thanks, Cathy

Thank you guys for responding so quickly. My appointment is tomorrow evening at 7. I'll let you know how things go. Thanks again, Cathy

Wow- thanks for the great advice. That is exactly what I was looking for. Cathy

Hello everyone - I have been reading pieces and parts to other threads about the 6 month diets with most of them being over a year old. I know insurance requirements change year to year and wanted to see if we could get a new thread for 2010 newbies. How cool would it be if we could get several of us together who are starting our life changing journey around the same time to share our experiences. We would be there for each other during everyones ups and downs (hopefully not many) until the day we all get approved. :biggrin: Here is my story. My first appointment will be in 2 days. I can hardly wait to get started and while several say that the 6 months will go by quickly I find it hard to believe at in the end I will say the same. My BMI is slightly over 40 and I don't have any real health issues. I had gallstones but the gallbladder is now gone, I had heavy random periods but had a hysterectomy 6 months ago. I can't decide whether to continue to see my PCP for my monthly weigh in's or see the surgeons dietitian. The dietitian would require a 2 hour drive (one way) and a half day of vacation each month. But I don't want to take the chance that my PCP would not put everything down that is needed for approval. Anyone else in this situation? Thanks, Cathy

Congratulations on your recent banding.:thumbup: Boy are we glad to chimed in - We are all ears. Cathy

Hi Ezzie 5, We are certainly glad you took the time to reach out too us and be a part of our group. We are here for ourselves and each other, we will all get through this with a very happy ending. It's a shame that your family is not more supportive of your decision. My husband has always had the "eat less and exercise more" and the weight will come off diet plan. Well it has not. I sit behind a desk at work (8 hours) and behind my computer after work (2 hours) and then do some quilting which again is on my butt. My motivation is great just my will power SUCKS. I bet your family is supportive in you losing weight just not this way and the reason is because they don't want to take a chance on losing you during the procedure. Selfish on their part but they do love you. When your husband starts seeing his cute, skinny, vibrate athletic wife again, he won't be able to keep his hands off. I was told that I would need to have a barium swallow before we would submit to insurance but when I told the dr. that I had a barium swallow the summer of 08, he said he could used that one instead of making me get another one done. That is a very simple easy exam, just drinking some liquid chalk. A lot easier than getting a mammogram. I go see a therapist this next week, my first ever. It is a requirement before submitting for approval. I was given a referral, made the appointment and hung up thinking what are we going to talk about. How long do we talk. Will I get something in writing and How much will this cost me? Unlike making an appointment at the doctors, they know what you are coming in for. Has anyone been to a therapist yet? Thanks, Cathy

I see some mention that they are getting or had a colonscopy, is this something for just those getting By-Pass? I had my first appointment this past week and we talked about a barium swallow but thankfully no colonscopy. So the question is: Has anyone got the band or is scheduled to get the band that was or will be required to get a colonscopy? Thanks, Cathy

Great news and welcome. Can't wait to hear your story.

Hello, I go for my first visit next (very excited). I was told that my first visit should take about 4 -6 hours and I would be visiting with several different people. What should I expect. Will this be my first and "Official" start weight, will they measure my height, will they do medical exams, draw blood, ekg, will they go over my entire medical history or will I just sit and talk (or listen) to several different people? I can't wait to get this started.

Hi Carmen74 I'll definitely look for that other thread so I want to hear from others that are going through the same thing that I am. You must be super excited about having your surgery so soon. I see it's been a long journey for you. How was the approval process with your insurance company?

Hi Majj - Glad to hear from you. I am just so excited to get started and have the ability to control my appetite. I know I will be just fine eating little amounts and look forward to the day that it happens. Just think about the money we will be saving by eating smaller amounts. I have a coworker that was banded 4 years ago. She started at 318 and is today at 144. When we order lunch, she takes the left overs home for dinner. She says it's the best decision she ever made and has absolutely no regrets. Are you getting your band on Feb 24th? I'm just starting and hoping to be banded by August.

Hi Betsy, Your words are real encouraging and I certainly hope things progress quickly. I have been reading and studying for quite a while and have no doubt this is what I want to do. I have Cigna Open Access which covers bariatric surgery 100% if all criteria are met. Cigna states: Failure of medical management including evidence of active participation within the last 2 years in a weight-management program that is supervised either with a PCP or a Registered Dietician for a minimum of 6 months without significant gaps. For individuals with long-lasting, morbid obesity, participation in a program within the last 5 years is sufficient if reasonable attendance in the weight-management program over an extended period of time of at least 6 months can be demonstrated. I am a little fuzzy on exactly how to interpret the above paragraph. Sounds to me that I can either qualify with the 2 year or 5 year requirement. I have 5 years of weight management with a PCP all coded as weight management visits. 7 visits in 2005 and around 4 visits each year for the remaining 4 years. Weights, diets and exercise are discussed on most visits, so I really don't know if Cigna will consider those visits I have provided the surgeon with 1 yr fitness center receipts, 1 yr curves receipts and receipt for purchase of my treadmill. I have no health problems except being fat. My gallbladder was removed 2 years ago tomorrow (Valentines day) and an oversized fibroid tumor with my uterus was removed 6 months ago. How do you interpret Cigna's diet requirement? Cathy

Thank you guys for taking the time to respond. I can't imagine how the next 6 months will go fast like others write. It will only be 2 weeks from the night of the seminar to my first appointment and I feel like a kid waiting for Christmas morning to come. Cathy

Hello- I have a BMI of 41.1 on the first appointment with the surgeon and a BMI of 39.3 on my first appointment with my PCP in the 6 month diet plan. Which BMI will be used to determine if co-morbidities are required? My plan states I qualify if I have a BMI over 40 or a BMI of 35 - 39 with at least 1 co-morbidity. Any ideas?

Hello everyone - Thanks for taking the time to read and hopefully respond. Here is my info. Insurance: Cigna Open Access BMI 39.4 Have had a BMI of over 35 for 10 years and can document it. Have 5 years of medically supervised diets (7 visits in 2005 with 6 of them consecutive - 4 visits in 2006, 5 visits in 2007, 4 visits in 2008 and 3 visits in 2009). Have copies of drs notes with their recommendations. Medications: Wellbutrin -taken for the past 5 years for depression. Metformin - have not been told that I have diabetes Synthroid - not aware of any problem with my thyroid Phentermine - gave me the jitters so quit Meridia - worked fine and lost weight while taking it Activity recipts: 1 year membership to local gym 2006 1 year membership to Curves (with measurements) 2007 purchased a treadmill - 2009 purchased a sleep number bed for back pain -2009 9 month activity with Life Coach - name and contact - 2009 Misc: copy of emergency room diagnose of GERD and ENT stating the same. Manage to control with foods and only filled prescription once. Definitely could sleep anytime but have never had a sleep test to determine if I have sleep apnea. History: 2009 - Fibroid Tumor removed (688gms) with uterus 2008 - Gallbladder removed 2000 - had fatty tumor removed from breast Well I think I have explained everything. I have been struggling with my weight for 29 years now and I am ready to have some help. That is some real lasting help. Do you think I have a chance in getting approved for the LAP-BAND® with Cigna? If you have any tips as well, please let me know. I have my first appointment on the 17th (10 days away) with a bariatric surgeon.