The 2 week wait begins...send me good vibes!

[Constance 0]

My local surgeon has just submitted all of the required materials to Cigna. The insurance processor said I should have a decision in 2 weeks. I have a PhD (ok, maybe a Master's compared to some of you) in jumping through hoops at this point:

6 months supervised "diet"

resting metabolic rate testing

blood work

EKG

Cardio pulmonary work up

Psych eval.

mandatory support group

Cigna is notoriously tough so I hope I have enough. The problem is, I learned recently that they want you to have a BMI of 40+ for at least a year. I hovered at 39 up until a few months ago. The insurance processor thought I acctually had a pretty good shot, though.

I so so hope I get approved! Please send you good vibes/prayers/happy thoughts this way

[dovie6523 0]

Good Karma...Good Karma! I know the waiting is the hardest part! Was you your diet "medically supervised" That sometimes is an issue. I know that I had to see my PCP each month for 6 months to qualify. I just got my approval yesterday! I have been working on this now since November of last year! Just keep plugging along!

[Constance 0]

Yes dovie, I went and saw my doctor and weighed in every month. She made notes about me exercise or diet as needed. I'm so anxious to just KNOW.

[Constance 0]

It's been a week...no word yet.

[Ariel 1]

I'm sending good vibes your way!! I'll keep my fingers crossed!

[Constance 0]

I got a denial letter today. Reason being: "Complete documentation of supervised 6 month weight loss program has not been received"

Okaaay?

As is not received at all? Or not "adequate"? I called Cigna. This just in, they are total douchebags and could scarcely pull up today's date. They will mail me all of the info my surgeon sent them. Couldn't they just tell me what specifically was wrong with the 6 months I submitted? Nope. So now I wait some more. I wish I had a big ol' chunk a change and I could just say eff it and do self-pay. I will if I have to, I just want to give the insurance a try. **sigh**

[DrewsLou 3]

I've been thinking about you Pelo!! I'm sorry you got denied.... hopefully it's a quick fix and they will aprove you! I'll keep my fingers crossed!

[Constance 0]

Aw thanks! I hope it is a simple issue, too. I asked my doctor to call in for a peer-to-peer review with the medical director at Cigna. I hope hope she does it TODAY! Thanks for the support!

[Constance 0]

The latest inews is my doctor called for the peer-to-peer. They wouldn't let her talk to a the medical director because she is a PA...not an MD! Well, why is she listed in Cigna's provider directory?! I've been seeing her 3 years and I consider her my doctor.

Anyway, they are not accepting my 6 months supervision. They DID get the paperwork but found it to be "inadeqaute". So I will go weigh in one more time next week and write a super pathetic letter. That is all I can do at this point.

[DrewsLou 3]

Keep your head up Pelo! Your in my thoughts girl! :biggrin1:

[Linda23585 0]

I'm so sorry about the denial. I am waiting to hear from my insurance....no news is good news??? My BMI is sitting at 39.8. They will also cover if it is 40 or more. I have made up my mind that I want this surgery and that I want it done asap. I do not like the waiting game.

[dpingl 0]

I feel very lucky! I barely meet the BMI minimums, I have asmatha and GERD. and was approved first letter within 3 weeks. I have an appt the 14th with the surgeon! I am excited but nervous both. I read these stories and I think I would have just given up!

[danie 0]

im so sure that can make me so mad, what about the diet was not adequate? i wish you luck i hope i dont have any problems the doc i see is also a pa ......

[Constance 0]

I'm going to call tomorrow (too late now) and ask specifically what needs to be documented or discussed in the 6-month supervision that I did not do. If my doctor can clarigy and re-submit, then great. If not, I am off to self-pay land. It really chaps my Buns that they so easily give you a denial and make it so vague!

[kickiegirl 0]

Hey...I spoke with a Cigna nurse after they denied my claim. She said at the monthly checks they require weigh-in, bp & pulse. Also discussion of what type of diet you are on, exercise program & behavior modification. However, I would HIGHLY recommend contacting the obesity lawyers Walter & Kelley Lindstrom. They work for you fighting insurance. Also Inamed, the manufacturer of LAPBAND, is doing a new program where if they feel you have a good case against insurance they will cover the lawyer fees. I've heard nothing but good things about these lawyers, and I was quite hesitant to pursue getting them to represent me, but I qualified for the Inamed program. I also look at it this way...you can self-pay or pay a small amount for a lawyer who has been fighting insurance companies for 10 years...that's if you don't qualify for the Inamed program. Which, it sounds like you should!!!!! Also you can speak to the lawyers for free and they can tell you if you have a good case. They will not represent you if they feel they can not win approval for you!

Here is their website.

http://www.obesitylaw.com/

Good luck! My thoughts are with you as you are on your journey to fight Cigna along with me!

:gluck: