I have Cigna. They require 3 months nutrition visits and psych evaluation. I plan to do those things anyway as I think they are important for success. Have already had Upper GI (discovered sliding hiatal hernia) and had Stress EKG today. My dr requires sleep study. She says 80% - 90% of her patients have sleep apnea and she is not comfortable doing surgery unless we are either told we don't have sleep apnea or treat the apnea with CPAP. My sleep study had been scheduled for tonight; however, insurance won't approve the sleep study. They said the clinic records did not show sufficient excessive daytime sleepiness that might indicate sleep apnea. I am sure dr. is going to appeal but it made me think, am I just going to have to have all these hassles all the way through the process? I can actually (blessedly) afford the surgery and wonder if perhaps I shouldn't just pay myself and not have to wait and jump through so many hoops. (For what it's worth, I am type II diabetic with 46 BMI.) I have a very stressful work schedule during the summer and really need to get the surgery done by early May in order to have a little time to focus on health before the worst of the stress hits or wait until October when it is all over (which I don't really want to wait for). I am worried that once my nutrition visits are completed (April 30), then Cigna won't approve or will hassle and have to go through appeals until we just land in mid-summer or later.

So, my question, should I just self-pay and skip all the mess?

Well I am certainly getting closer. Finally did the sleep study (at home). I DIDN'T have sleep apnea which I knew all along but dr required it. (One of the few conditions from being obese that I don't have! ). I have my last nutritionist visit on April 29 and then they should be able to submit for approval. One of my NUT appts was too close together (only 2 weeks instead of 4 weeks) so I bet Cigna makes me have 1 last appt. (Frustrating. I told that person I was supposed to wait 4 weeks, but they wouldn't listen. Still using the same surgeon but now a different location where there are different nutritionists and patient reps, etc.) Still seeing counselor - mostly once per week. Having some doubts about the surgery right now, but I think it's just cold feet. I have an appt with my endocrinologist tomorrow to discuss sleeve vs bypass to make sure I meet requirements for bypass. (I have a lot of other medical issues that won't go away with RNY and need to make sure RNY won't affect those health issues by keeping me from using the correct supplements, meds, etc.) Will feel more certain after I talk to him I think.

Anyway, long story to say, thanks. I am still moving forward.

UPDATE - My endocrinologist recommended me for the surgery. He said it is going to affect some of my other medical issues but that we can deal with them as they come up. Had my last nutritionist visit and surgeon submitted to Cigna on Friday at noon for approval and drumroll please.... Cigna approved me!! Already - less than 24 business hours! So, now I am waiting on call from surgery scheduler. Excited and nervous!!

This is why you pay insurance so it will be there when you need it.

As previous poster put it, save your money for plastics.

Has anyone heard of Global Health approving for the surgery?

No this is the normal

I was very frustrated by the wait to complete all of Cigna's pre surgical requirements. It seemed like it took forever to get through it all. Now that I am post op, I am glad it took some time. It gave me time to mentally prepare, break some bad habits, and start adding positive behaviors. Cigna was pretty efficient with the pre authorization. Their policy is to issue a decision within 5 business days for inpatient surgical procedures and they met that.

You are the only one who can decide which course is best for your needs. I can say Cigna was pretty good about the pre authorization process. Make sure you read and understand Cigna medical coverage policy 0051 dated 05/15/2014. You can use the policy to ensure you complete every required step and proof of every step is collected and submitted. One item in the policy that isn't really clear is the physician monitored weight loss attempt. The policy says you need 3 consecutive months (> or = to 89 days) of physician or dietician monitored weight management program. To meet that requirement, you actually need 4 appointments because an initial appointment to start the process is required. Make sure you also schedule each appointment at least 30 days apart too. The link for the policy is https://cignaforhcp.cigna.com/public/content/pdf/coveragePolicies/medical/mm_0051_coveragepositioncriteria_bariatric_surgery.pdf

Good luck with everything! I can't wait to see your progress and to cheer you on!

s is where I got hung up today. They will correct and resend. Hoping that will fix it!