Band to Sleeve with Cigna

[LSF 264]

Does anyone have Cigna that went from the band to the sleeve? If so, how long did the approval take and what was your BMI? I'm worried because I gained most of my weight back but I don't have any medical issues like diabetes or high blood pressure and my BMI is a 39.1 instead of the 40 requirement. My surgeon want to do the revision - we are getting ready to submit the paperwork.

[doingitforme29 8]

Gain approximately 5lbs! It should increase your BMI. Also, look for any health issues you might have such as anemia, asthma, etc. After your BMI reaches 40 submit dated photos for the past three years instead of physicians records.

[steelemagnolia 7]

Wonderful advice! Eating Blizzards every day! LOL Just kidding! Do you have any symptoms of sleep apnea? Arthritus? High bloop pressure? Any other complications that losing weight will improve. Any reason that really should make you healthier in the future.

[LSF 264]

I do have arthritis in my knee but not high blood pressure. I don't want to deliberately gain weight but am wondering if I can go in for 1 more weigh in and wear heavier clothing - then submit that as my official paperwork. The surgeon had to remove some Fluid from my band because of the pain i've been experiencing = I went for the

barium swallow test and they saw acid reflux and a hiatel hernia which I had before the band and he repaired it during the lapband surgery back in 2008. My appetite had increased since he removed the Fluid.< /p>

[Jersrose43 837]

The rules are a little different with revision

See the policy attached page 3 for reoperation

See if you qualify. The rules can be different

https://cignaforhcp.cigna.com/public/content/pdf/coveragePolicies/medical/mm_0051_coveragepositioncriteria_bariatric_surgery.pdf

[LSF 264]

Let me ask you a question- I called Cigna and they confirmed that revision coverage is different than starting from scratch and showed the 4 bullet points. I qualify for all but 1 - the one about the band causing the medical problem. The surgeons office said that because of that- I need to see the nutritionist, psyc etc... So that it will be easier to get approved in 3 months vs no wait with the revision. I'm worried that after all that hardwork- what else do I need to do

[Jersrose43 837]

Do you have documented proof of the problem? Medical records at physician with complaints?

[bearhugs1975 57]

I was approved for my revision (not Cigna but Health Alliance) because I have to have a couple of Unfills for too tight. They presented that as a slight prolapse, although never bad at all. Was approved in 2 days. Maybe an option?

[LSF 264]

The surgeons office was pretty adamant that it wouldn't qualify - I did go through a year of throbbing chest pain around the band - we did the Barium Swallow test a year ago and it showed no problems - the band was tight but I was able to eat alot. When I went a few weeks ago to start this process - I had the Test done again because of the pain - still no signs of any problem with the band - just reflux so he removed 2 cc's and now I feel much better. Because it's Cigna - they don't want to submit anything until it's all completed because having to appeal is more difficult.

[Gendy 27]

I too have no recordable issues with the band other than I wasn't losing weight. So the Dr suggested the sleeve, and that that time my BMI was 40. I have since lost weight and my BMI is now below 40. The Dr's office said that losing weight is good because it shows them that I'm serious about losing weight. If I had gained weight they wouldn't have submitted my paperwork to the insurance company. I'm waiting to see if I get approved or not. I have BCBS.

[LSF 264]

I've started the 90 day journey - I just attended my first support group meeting and next week have appointments with the nutritionist and psychiatrist. It stinks that we have to go through it all over again for revision surgery just because there are no serious complications - just minor ones.

[peacheeie 14]

I'm very confused because I'm going though this as well....page 3 of CIGNA's policy states nothing in the paragraph regarding re operation or replacement surgery. I have been denied 2x's for (1) a sleeve and (2) another lap band due to lack of documentation and this was after my band was removed due to "erosion" on 9/19. I am so confused as to why and what I need to do....CIGNA says they need everything like I was starting this journey from scratch, my surgeon says no because it's a replacement, however CIGNA says there is nothing documented from surgeon that it's a replacement...wtf????!!! BMI is climbing, have numerous co mortalities etc. getting 2 completely different stories...just feel like surgeon is dropping the ball...how do you submit for approval and not have all your documentation? I should have been going to nutrition classes, psyc, etc and they just keep saying for me to wait...Never been so confused in all my life....some posts that have CIGNA say they didn't need the 3 months, some do...how is this possible??

[Jersrose43 837]

You need to stop talking to your doctor and talk to cogna.

If they've denied it find out exactly why

Appeal it in writing address each point of the denial with proof of the requirement.

Pm me if you need assistance

[LSF 264]

You should do all the stuff like nutritionist etc... I've already met with the psychiatrist and once with the nutritionist. Just start now so you can get the ball rolling

[peacheeie 14]

Ty Ty Ty! I have spoken to CIGNA and they said it was denied (2x time) due to the fact that I have no documentation on a weight loss program, 3 months of recorded weights, nutritional appt, psyc etc. all the criteria needed from the word GO! I already started moving ahead on my own because I just don't feel like they are pushing for me. If I needed to do this stuff I would have done more in these last 2 months than I have. Apparently I have a surgery date of dec 5th....yea, I'm sure