Borderline BMI - a waste of time and you still pay?

[Constance 0]

My BMI is 39. If I want to have Cigna cover the lap-band I need 6 months of supervised diet and exercise. Well of course I can probably take off 10lbs, (it's keeping it off that has been a life long struggle) but then I'll have lost some of the BMI - making me less of an "appropriate" candidate for coverage. You need to have a BMI of 40 to qualify.

Or, do I just suck it up and self-pay, assuming I may have to pay anyway even after the supervised diet?

Any advise or suggestions?

edited to add: I have no co-morbidities and am very healthy.

[Jachut 487]

Its so stupid isnt it? YOu could lose a LOT of weight on a supervised diet and still be back to have a lap band 2 years later.

If you could do it I would self pay. Its so much different here, all you have to say is yes I've done Weight Watchers, Jenny Craig blah blah blah and no it hasnt worked.

But your'e right, you dont want to lose weight but still be obese and no longer qualify for surgery. You could always do the 6 month stint though and purposely not lose weight at all, protesting that you have no idea why!

[Constance 0]

I thought about faking to diet part, too. I certainly know how to blow a diet! But then I thought, what if they say "Well, then let's have you try for another 6 months"

[Mvpo8961 1]

CIGNA is notorious for NOT covering the WLS. They say under their bariatric surgery policy that MOST CIGNA policies do not cover WLS. I know I had CIGNA and was told by our employee benefits coordinator that is was a covered benefit. I started the six month program but I always had a niggling feeling that I was getting bad information. After numerous attempts to get the information in WRITING I was told that it indeed was NOT a covered benefit. I called the National Representative (CIGNA's) for our employer for added verification.

I think first I would get with the Benefits Coordinator and get/see it in writing where it is not excluded.

[lotsofkids 0]

I only have a BMI of 35....but I have a strong apnea that is considered a co-morbidity. If you have hypertension or diabetes...they too are comorbidities...and that can increase your chances of getting approved medically.

I will probably be in for a fight with my insurance...and I don't know if they will come through....but I will take the challenge and aggressively go after them with re-submitals and appeals....if that is what is needed.

hope things work for you....

hugs...diane

[CCBSTX 0]

I'd suggest "jumping through the hoops" so to speak. Go on their "diet" and not really diet. If you feel that it will be another lose weight, gain back more scenario. Shawn

[dovie6523 0]

I am going through the same thing. Talk about a "catch22" (did I just date myself?!)LOL. Anyway, it is crazy. If I could of done it myself with diet and exercise, I would have. This is just another loop hole they want us to jump through, hoping that we will give up! I have been fat my whole life, what's 6 more months! Hopefully come July, I will be approved! Just hang in there. If you can't really afford to self pay... (like me) What's 6 more months. It will be here before you know it! (I keep telling myself) I am excited and don't want to wait either, but hang in there!

[princess_n_thep 2]

I suggest that if you do have the money. Self pay then. I think it was much easier to self pay due to the non-stress I had of not fighting anyone but my own mind and pocketbook.

[lianna 3]

Do you have any comorbitities? Blood pressure, blood sugar, sleep apnea, etc..? Get a complete workup in the meantime, and if you have any weight related complications usually insurance will cover a BMI of 35 with comorbids. If that is the case you can still do the supervised diet and take off some pounds PRIOR to surgery. If you are completely healthy and just overweight you are in the "catch 22" of this process.

[leatha_g 4]

Sorry, I didn't read all the answers to this question, so forgive me If I'm redundant.

Just so you know, I'm not so sure this about proving you can lose weight. It may very well be about proving you can't lose weight on your own.

My sister in law was just banded, after her year of 'supervised' weight loss documentation for BCBS. She didn't lose an ounce. Maybe even gain additional weight in the interim. Mostly, I think it's more a tactic to see if you'll give up and try to 'just do it on your own'. Maybe, it's a year to think about whether you really, seriously want something as drastic as a life altering weight loss surgery? Something to think about... any other thoughts?

[SkyeBlu 0]

I started my journey to WLS April of last year and was banded Feb 10th. I had a borderline BMI of 39 as well. The supervised program was a joke and I even gained a few pounds due to the stress of the whole mess. My insurance provider is one that is notorious for denying the surgury but when it was all said and done and I jumped through the hoops a surgery that was going to cost me $15-20,000 out of pocket cost me $4,000 after insurance covered their part. To me it was worth it, but that is a decision you need to make for yourself. My thoughts were the same as Dovie....I have been lugging around most of this weight for years so what was 6 more months?

I wish you the best of luck!

[Constance 0]

Skye did you have any co-morbidities? I don't have any. Which a surgeon I consulted with seemed surprised about considering my weight. He said "well, don't your feet hurt at least?" Um, no, thanks, my feet have somehow managed to support all this extra weight. (I know he was just trying to be creative with insurance - but still!)

leatha g, that is a good point, about just taking the time to think while i do the supervised diet. I have more to say on that and I think I'll post on the main board.

[SkyeBlu 0]

I did have some co-morbidities....

High cholesterol

Severely degenerated lumbar spine (had to have emergency back surgery Feb 05

sleep Apnea

Acid Reflux

Problems with my knees

Minor heart attack Oct 05

And the insurance STILL gave me a hard time! Doctors on the other hand were fighting tooth and nail for me!

[fatmary 0]

I have Harvard Pilgram and I have not started the battle yet. I am a mere 33 BMI. I have sleep apnea that is so bad that I may be forced to do that surgery--which seems far worse than this one. I had a mini stroke 6 months ago. I have high BP and my feet hurt, really hurt, all the time. Do I have a prayer of getting it covered??

[fatmary 0]

Crap...the sad truth is I could pack on 20 extra pounds with no trouble at all...and I know that is not the right idea. But I will give it a try anyway.