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B.J.

By B.J., in PRE-Operation Weight Loss Surgery Q&A

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MaReeJo78    5

MaReeJo78
Posted

I called Cigna and they told me that if I were to have lost a lot then it wouldn't be a need for surgical intervention. They said if anything it would benefit my request for approval and prove my struggle with weight loss. Suprised! I submitted to Insurance today too. Now im excited.

Have you heard anything back from Cigna? I have cigna also and just curious if you got approved. Good luck!

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B.J.    16

B.J.
Posted

Have you heard anything back from Cigna? I have cigna also and just curious if you got approved. Good luck!

I called friday around 4pm and they told me that my file has been sent to the medical director for review and i should know something by Monday(today) around noon. Cross your fingers. How far are you in the process?

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MaReeJo78    5

MaReeJo78
Posted

I called friday around 4pm and they told me that my file has been sent to the medical director for review and i should know something by Monday(today) around noon. Cross your fingers. How far are you in the process?

*Fingers crossed*

I have had my psych eval, 3 medically supervised diet appointments, and I've met with the nutritionist. Now I just need my letter for medical necessity and one more seminar through the surgery center/hospital and then I will be submitting all of it to Cigna for approval.

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B.J.    16

B.J.
Posted

So I got the phone call today. I got denied. They told me that my packet lacked one piece of information that was necessary. Even tho my PCP wrote a letter of approval and stated it was medically necessary, she didnt write a letter that stated I was "Cleared for Surgery". So I will have to appeal. It's upsetting that this isn't even a requirement on my plan. But no stressing...

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MaReeJo78    5

MaReeJo78
Posted

So I got the phone call today. I got denied. They told me that my packet lacked one piece of information that was necessary. Even tho my PCP wrote a letter of approval and stated it was medically necessary, she didnt write a letter that stated I was "Cleared for Surgery". So I will have to appeal. It's upsetting that this isn't even a requirement on my plan. But no stressing.

Oh no that terrible! Hopefully it is an easy fix and you'll be back on schedule to start your new life!

Good luck and keep us posted!

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luv2nurse    7

luv2nurse
Posted

So I got the phone call today. I got denied. They told me that my packet lacked one piece of information that was necessary. Even tho my PCP wrote a letter of approval and stated it was medically necessary' date=' she didnt write a letter that stated I was "Cleared for Surgery". So I will have to appeal. It's upsetting that this isn't even a requirement on my plan. But no stressing...[/quote']

So I have cigna too. The same thing happened to me, it took 3 times before they approved. Just have your surgeons office resubmit everything again including the letter stating you are cleared for surgery and then you should be approved. No need for an appeal yet! You really have to stay on them. Hope this helps. Good luck!!!

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bloreorbust    286

bloreorbust
Posted

The same happened to me with Cigna. I had to go get a surgical clearance from my PCP, which was basically like a physical with some blood drawn. And that did the trick. Good luck to you!

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rlm34    42

rlm34
Posted

So I got the phone call today. I got denied. They told me that my packet lacked one piece of information that was necessary. Even tho my PCP wrote a letter of approval and stated it was medically necessary' date=' she didnt write a letter that stated I was "Cleared for Surgery". So I will have to appeal. It's upsetting that this isn't even a requirement on my plan. But no stressing...[/quote']

Fingers crossed it all comes thru next time.

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TurnThePage    220

TurnThePage
Posted

I believe a letter of clearance from your PCP is a standard requirement for virtually all surgeries. Your surgeon's office staff was to blame for not making sure it was included in the application they submitted. They know better than to send an app without one.

You'll have to stay on top of the staff there to make sure the situation is quickly rectified and you have confirmation of approval. Take very good notes of any conversations in case things go sideways. Hopefully, you will join us on the loser's bench soon!

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B.J.    16

B.J.
Posted

I believe a letter of clearance from your PCP is a standard requirement for virtually all surgeries. Your surgeon's office staff was to blame for not making sure it was included in the application they submitted. They know better than to send an app without one. You'll have to stay on top of the staff there to make sure the situation is quickly rectified and you have confirmation of approval. Take very good notes of any conversations in case things go sideways. Hopefully' date=' you will join us on the loser's bench soon![/quote'] I have been told that from many people now that I have been denied. Sucks that I didn't know that before. I called the surgeons office and the staff stated that it was an oversight like you said. To be honest, I'm kinda pissed.

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B.J.    16

B.J.
Posted

Fingers crossed it all comes thru next time.
thanks. Rlm34 and good luck to you too bloreorbust

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Go To Topic Listing PRE-Operation Weight Loss Surgery Q&A

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    • Aunty Mamo

      Aunty Mamo

      Iʻm roughly 6 weeks post-op this morning and have begun to feel like a normal human, with a normal human body again. I started introducing solid foods and pill forms of medications/supplements a couple of weeks ago and it's really amazing to eat meals with my family again, despite the fact that my portions are so much smaller than theirs. 
      I live on the island of Oʻahu and spend a lot of time in the water- for exercise, for play,  and for spiritual & mental health. The day I had my month out appointment with my surgeon, I packed all my gear in my truck, anticipating his permission to get back in the ocean. The minute I walked out of that hospital I drove straight to the shore and got in that water. Hallelujah! My appointment was at 10 am. I didn't get home until after 5 pm. 
      I'm down 31 pounds since the day of surgery and 47 since my pre-op diet began, with that typical week long stall occurring at three weeks. I'm really starting to see some changes lately- some of my clothing is too big, some fits again. The most drastic changes I notice however are in my face. I've also noticed my endurance and flexibility increasing. I was really starting to be held up physically, and I'm so grateful that I'm seeing that turn around in such short order. 
      My general disposition lately is hopeful and motivated. The only thing that bugs me on a daily basis still is the way those supplements make my house smell. So stink! But I just bought a smell proof bag online that other people use to put their pot in. My house doesn't stink anymore. 
       
      · 0 replies
      1. This update has no replies.
    • BeanitoDiego

      BeanitoDiego

      Oh yeah, something I wanted to rant about, a billing dispute that cropped up 3 months ago.
      Surgery was in August of 2023. A bill shows up for over $7,000 in January. WTF? I asks myself. I know that I jumped through all of the insurance hoops and verified this and triple checked that, as did the surgeon's office. All was set, and I paid all of the known costs before surgery.
      A looong story short, is that an assistant surgeon that was in the process of accepting money from my insurance company touched me while I was under anesthesia. That is what the bill was for. But hey, guess what? Some federal legislation was enacted last year to help patients out when they cannot consent to being touched by someone out of their insurance network. These types of bills fall under something called, "surprise billing," and you don't have to put up with it.
      https://www.cms.gov/nosurprises
      I had to make a lot of phone calls to both the surgeon's office and the insurance company and explain my rights and what the maximum out of pocket costs were that I could be liable for. Also had to remind them that it isn't my place to be taking care of all of this and that I was going to escalate things if they could not play nice with one another.
      Quick ending is that I don't have to pay that $7,000+. Advocate, advocate, advocate for yourself no matter how long it takes and learn more about this law if you are ever hit with a surprise bill.
      · 0 replies
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    • BeanitoDiego

      BeanitoDiego

      Some days I feel like an infiltrator... I'm participating in society as a "thin" person. They have no idea that I haven't always been one of them! 🤣
      · 0 replies
      1. This update has no replies.
    • ChunkCat

      ChunkCat

      Thank you everyone for your well wishes! I totally forgot I wrote an update here... I'm one week post op today. I gained 15 lbs in water weight overnight because they had to give me tons of fluids to bring my BP up after surgery! I stayed one night in the hospital. Everything has been fine except I seem to have picked up a bug while I was there and I've been running a low grade fever, coughing, and a sore throat. So I've been hydrating well and sleeping a ton. So far the Covid tests are negative.
      I haven't been able to advance my diet past purees. Everything I eat other than tofu makes me choke and feels like trying to swallow rocks. They warned me it would get worse before it gets better, so lets hope this is all normal. I have my follow up on Monday so we'll see. Living on shakes and soup again is not fun. I had enough of them the first time!! LOL 
      · 0 replies
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    • BeanitoDiego

      BeanitoDiego

      Still purging all of the larger clothing. This morning, a shirt that I ADORED wearing ended up on top. Hard to let it go, but it was also hard to let go of those habits that also no longer serve my highest good. Onward and upward!
      · 0 replies
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