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So Upset.......please Need Advice And Input!



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I do agree & we are probably not using the same definitions. ALL policies are a binding contract between the policy holder & insurance carrier & it pays to know exactly what you have. The only time that I know when there is no recourse is when it is a 'benefit exclusion' (not a covered benefit).

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I was planning on introducing myself.... and so happy to tell everyone that my surgery date is set for Oct 8. I have done the six month supervised diet,all the preop tests everything that was required. I came home tonight and received a letter from Cigna stating at this time they do not feel there is medical necessity for this surgery and that I should send more documentation to support the necessity. I am 275 lbs 5'3,my BMI is 50 ....Really...my knees hurt,Im tired all the time,my back,feet hurt etc and oh yeah I want to live longer,be healthier,see my kids grow..Im so ready in every sense of the word for this.I have a bad feeling.I do not have diabetes or high blood pressure,so if a BMI of 50

being 275 lbs at 5'3 is not enough and not having any comorbitities (sp) Im not sure what I can do.I feel like Im going to have a fight on my hands.I mean the good news is it said this is not a denial letter,but I am just not sure what more I can send them to warrant the surgery. Please any advice is welcomed I wanna so bad join all of you on that loosers bench. I get so inspired and excited reading all of your stories on here.

Have you talked with your primary care physician? Your regular doctor should have all sorts of medical history for you. Maybe there is some useful info in your file and your regular doctor will write a letter of recommendation. Mine did, which was the start of this process for me. I also had records of prior weight loss attempts from a diet center, Weight Watchers, etc., and even history of my primary care physician trying to help me lose weight. Think of anything at all that you can submit.

Good luck, it sounds like you will prevail on this.

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I was planning on introducing myself.... and so happy to tell everyone that my surgery date is set for Oct 8. I have done the six month supervised diet,all the preop tests everything that was required. I came home tonight and received a letter from Cigna stating at this time they do not feel there is medical necessity for this surgery and that I should send more documentation to support the necessity. I am 275 lbs 5'3,my BMI is 50 ....Really...my knees hurt,Im tired all the time,my back,feet hurt etc and oh yeah I want to live longer,be healthier,see my kids grow..Im so ready in every sense of the word for this.I have a bad feeling.I do not have diabetes or high blood pressure,so if a BMI of 50

being 275 lbs at 5'3 is not enough and not having any comorbitities (sp) Im not sure what I can do.I feel like Im going to have a fight on my hands.I mean the good news is it said this is not a denial letter,but I am just not sure what more I can send them to warrant the surgery. Please any advice is welcomed I wanna so bad join all of you on that loosers bench. I get so inspired and excited reading all of your stories on here.

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I was planning on introducing myself.... and so happy to tell everyone that my surgery date is set for Oct 8. I have done the six month supervised diet,all the preop tests everything that was required. I came home tonight and received a letter from Cigna stating at this time they do not feel there is medical necessity for this surgery and that I should send more documentation to support the necessity. I am 275 lbs 5'3,my BMI is 50 ....Really...my knees hurt,Im tired all the time,my back,feet hurt etc and oh yeah I want to live longer,be healthier,see my kids grow..Im so ready in every sense of the word for this.I have a bad feeling.I do not have diabetes or high blood pressure,so if a BMI of 50

being 275 lbs at 5'3 is not enough and not having any comorbitities (sp) Im not sure what I can do.I feel like Im going to have a fight on my hands.I mean the good news is it said this is not a denial letter,but I am just not sure what more I can send them to warrant the surgery. Please any advice is welcomed I wanna so bad join all of you on that loosers bench. I get so inspired and excited reading all of your stories on here.

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Sorry for quoting your post twice , I am replying on my nook and it doesnt seem to be app friendly on here, anyway I also received a letter from cigna stating they didnt see a medical necessity... i contacted my surgery cordinator and she worked with my pcp on a letter that stated medical necessity and i was approved , as a matter of fact I called and found out today .... do not let that letter bring you down ..... I have a sept 17 date and started my pre op liquid diet today.....

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    • Prdgrdma

      So I guess after gastric bypass surgery, I cant eat flock chips because they are fried???  They sell them on here so I thought I could have them. So high in protein and no carbs.  They don't bother me at all.  Help. 
      · 1 reply
      1. NickelChip

        It's possible for a very high fat meal to cause dumping in some (30% or so) gastric bypass patients, although it's more likely to be triggered by high sugar, or by the high fat/high sugar combo (think ice cream, donuts). Dietitians will tell you to never do anything that isn't 100% healthy ever again. Realistically, you should aim for a good balance of protein, carbs, and fat each day. Should you eat fried foods every day? No. Is it possible they will make you sick? Maybe. Is it okay to eat some to see what happens and have them for a treat every now and again? Yes.

    • NovelTee

      I'm not at all hungry on this liquid pre-op diet, but I miss the sensation of chewing. It's been about two weeks––surgery is in two days––and I can't imagine how I'll feel a couple of weeks post-op. Tonight, I randomly stumbled upon a mukbang channel on YouTube, and it was strangely soothing... is it just me, or is this a thing? 
      · 1 reply
      1. NickelChip

        I actually watched cooking shows during my pre-op, like Great British Baking Show. It was a little bizarre, but didn't make me hungry. I think it was also soothing in a way.

    • Clueless_girl

      How do you figure out what your ideal weight should be? I've had a figure in my head for years, but after 3 mths of recovery I'm already almost there. So maybe my goal should be lower?
      · 3 replies
      1. NickelChip

        Well, there is actually a formula for "Ideal Body Weight" and you can use a calculator to figure it out for you. This one also does an adjusted weight for a person who starts out overweight or obese. https://www.mdcalc.com/calc/68/ideal-body-weight-adjusted-body-weight

        I would use that as a starting point, and then just see how you feel as you lose. How you look and feel is more important than a number.

      2. Clueless_girl

        I did find different calculators but I couldn't find any that accounted for body frame. But you're right, it is just a number. It was just disheartening to see that although I lost 60% of my excess weight, it's still not in the "normal/healthy" range..

      3. NickelChip

        I think it's important to remember that the weight charts and BMI ranges were developed a very long time ago and only intended to be applied to people who have never been overweight or obese. Those numbers aren't for us. When you are larger, especially for a long time, your body develops extra bone to support the weight. Your organs get a little bigger to handle the extra mass. Your entire infrastructure increases so you can support and function with the extra weight. That doesn't all go away just because you burn off the excess fat. If you still had a pair of jeans from your skinniest point in life and then lost weight to get to the exact number on the scale you were when those jeans fit you, chances are they would be a little baggy now because you would actually be thinner than you were, even though the scale and the BMI chart disagree. When in doubt, listen to the jeans, not the scale!

    • Aunty Mamo

      Tomorrow marks two weeks since surgery day and while I'm feeling remarkably well and going about just about every normal activity, I did wind up with a surface abscess on on of my incision sights and was put on an antibiotic that made me so impacted that it took me more than two hours to eliminate yesterday and scared the hell out of me. Now there's Miralax in all my beverages that aren't Smooth Move tea. I cannot experience that again. I shouldn't have to take Ativan to go to the lady's. I really looking forward to my body getting with the program again. 
      I'm in day three of the "puree" stage of eating and despite the strange textures, all of the savory flavors seem decadent. 
      I timed this surgery so that I'd be recovering during my spring break. That was a good plan. Today is a state holiday and the final day of break. I feel really strong to return to school tomorrow. 
      · 0 replies
      1. This update has no replies.
    • BeanitoDiego

      Now that I'm in maintenance mode, I'm getting a into a routine for my meals. Every day, I start out with 8-16 ounces of water, and then a proffee, which I have come to look forward to even the night before. My proffees are simply a black coffee with a protein powder added. There are three products that I cycle through: Premier Vanilla, Orgain Vanilla, and Dymatize Vanilla.
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      For second breakfast on non-workdays, I will prepare two servings of plain, instant oatmeal with a tablespoon of an olive oil-based spread. This means I will have had 34 grams of protein, 365 calories, and 38 carbs. Non-workdays are when I am being very active with training sessions, so I allow myself more carbohydrate fuel.
      Snacks on any day are always mixed nuts, even when I am travelling. I will have 0.2 cups of a blend that I make myself. It consists of dry roasted peanuts, cashews, pumpkin seeds, sunflower seeds, pistachios, and Brazil nuts. This is 5 grams of protein, 163 calories, and 7 carbs.
      Breakfast and snacks have been the easiest to nail down. Lunch and dinner have more variables, and I prepare enough for leftovers. I concentrate on protein first, and then add vegetables. Typically tempeh, tofu, or Field Roast products with roasted or sautéed vegetables. Today, I will be eating leftovers from last night. Two ounces of tempeh with four ounces of roasted vegetables that consist of red and yellow sweet peppers, sweet potatoes, small purple potatoes, zucchini, and carrots. I will add a tablespoon of olive oil-based spread, break up 3 walnuts to sprinkle of top, and garnish with two tablespoons of grated Parmesan cheese. This particular meal will be 19 grams of protein, 377 calories, and 28 grams of carbs. Bear in mind that I do eat more carbs when I am not working, and I focus on ingesting healthy carbs instead of breads/crackers/chips/crisps.
      It's a helluva journey and I'm thankful to be on it!
       
      · 0 replies
      1. This update has no replies.
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