Jump to content
×
Are you looking for the BariatricPal Store? Go now!

Recommended Posts

Hello,

I'm new to the forum world so bear with me. Any who, I went to my surgeons office for my pre-op and to get a surgery date. This company is soooooo unorganized! I was done with diet & nutrition last month... They dropped the ball with my insurance as far as updating it even though I kept telling them as of Jan 1st I had new insurance. Well, same company but now I have out of network coverage. Anywho they switched me surgeons and come to find out the soonest they have for surgery is March 14th* if a patient cancells, OR March 31st. Grrrrrrrrrrrrrr!!!!!!!!!!! This is ridiculous. I was done with my check list on the 5th of this month. My surgeon said he has an opening on Tuesday, yes that's 4 business days away... BUT I don't have my insurance approval yet. They just barely submitted TODAY. I'm so irritated. Anyone have experience with Cigna open access plan? I know we all hear the basic 5 - 10 business days with a max of 30 days to respond but I need to know does it really take this long?!

Share this post


Link to post
Share on other sites

Cigna approved mine in 24 business hours (submitted Friday at noon and approved Monday morning before noon). Fingers crossed yours will go just as fast!

Share this post


Link to post
Share on other sites

A doctor to doctor conference call will usually get the job done.

Share this post


Link to post
Share on other sites

Daisee68, thank you so much for replying! That totally gives me hope! I know they're pretty good with claims, as far as processing ASAP so I'm hoping approval is the same. The employee in charge of submitting was just so negative... she kept telling me, well I can't even escalate it until it's been 5 business days blah blah blah.

So when is/was your surgery date?!

Thank you!

- Nancy

Cigna approved mine in 24 business hours (submitted Friday at noon and approved Monday morning before noon). Fingers crossed yours will go just as fast!

Share this post


Link to post
Share on other sites

Thanks for your reply Valentina!

Yeah that's what the surgeon said, he was like I'll call them if I have to... he was more helpful than his staff! Unbelievable. If I wasn't so close to getting this thing done, I would find another clinic. Ugh.

-Nancy

A doctor to doctor conference call will usually get the job done.

Share this post


Link to post
Share on other sites

@@n_green825 - will keep my fingers crossed for you! So glad your surgeon agreed to get involved! My surgery was June 4 last year. I'm down a total of 128 pounds (27 of that before surgery diet and liquid per-op diet).

Sent from my HTC One M9 using BariatricPal

Share this post


Link to post
Share on other sites

Oh, I just noticed your ticker, Lol. That is so awesome, congrats! I cannot wait to start shedding some pounds! I'm on the pre-op diet now, 2 shakes a day, small healthy dinner... but with my surgery date up in the air, I'm losing motivation. My starting weight will be 252, with a goal of losing 110pds. I'm a shorty... 5'2" Lol.

@@n_green825 - will keep my fingers crossed for you! So glad your surgeon agreed to get involved! My surgery was June 4 last year. I'm down a total of 128 pounds (27 of that before surgery diet and liquid per-op diet).

Sent from my HTC One M9 using BariatricPal

Share this post


Link to post
Share on other sites

I have Cigna as well and as of today I have been denied twice. My procedure is set for the 23rd and I have been on pins and needles waiting for a response for the second denial. The lady at the surgeons office said that the Cigna I have rarely denies claims. There is a Dr to Dr call tomorrow between my surgeon and the Med Director so hopefully all will work out. I am praying.. Stressed but praying.

Share this post


Link to post
Share on other sites

@@Chair1311 - So sorry this has happened. Hopefully the dr call will help. What was the reason they gave for denial?

Share this post


Link to post
Share on other sites

@@Chair1311 - So sorry this has happened. Hopefully the dr call will help. What was the reason they gave for denial?

The first denial was a lack of a signature from the nutritionist. This time, I don't know. The lady at the surgeons office didn't know either.

Share this post


Link to post
Share on other sites

The lack of a signature????????? WTH???? I would go and visit with the office administrator and together go over EVERY line of your forms. Someone's careless submission of an incomplete form should NEVER be a reason for a patient's application to be denied. OMG!

You don't have to be abrasive or disruptive, just "gently assertive"...

I would also "gently assert" that you "need and expect" your surgeon to indeed make the "doctor to doctor" conference call.

I'm trying to think of a time during my years as a medical facility administrator when a doctor to doctor conference call did not work. I can not think of ONE. As far as my memory will allow, the doctor to doctor call works. It makes it personal. Especially when one remembers that most of the time, the people making the "approve/deny" decisions are NOT doctors, but money crunchers. Scary, isn't it?

PLEASE, keep us posted. We care and am rooting for you.

Share this post


Link to post
Share on other sites

The lack of a signature????????? WTH???? I would go and visit with the office administrator and together go over EVERY line of your forms. Someone's careless submission of an incomplete form should NEVER be a reason for a patient's application to be denied. OMG!

You don't have to be abrasive or disruptive, just "gently assertive"...

I would also "gently assert" that you "need and expect" your surgeon to indeed make the "doctor to doctor" conference call.

I'm trying to think of a time during my years as a medical facility administrator when a doctor to doctor conference call did not work. I can not think of ONE. As far as my memory will allow, the doctor to doctor call works. It makes it personal. Especially when one remembers that most of the time, the people making the "approve/deny" decisions are NOT doctors, but money crunchers. Scary, isn't it?

PLEASE, keep us posted. We care and am rooting for you.

Oh I have been on the phone so much with both my insurance and my surgeons office they probably have memorized my phone number! Lol I am praying with everything I have. I work in an emergency room so we never have to deal with insurance claims and authorizations. My Dr will be on the call tomorrow. Apparently he has been just as shocked as I that I wasn't approved! Thank you so much for your advice and encouragement. I will let y'all know how it turns out.

Share this post


Link to post
Share on other sites

@@Chair1311, Oh nooooooooo!!! That's horrible, I'm so sorry! Keep us posted! I know it's only been 2 days since they submitted, but I feel like calling Cigna today anyway and seeing if I even have a case # or something I can track. I HATE the waiting game!

I have Cigna as well and as of today I have been denied twice. My procedure is set for the 23rd and I have been on pins and needles waiting for a response for the second denial. The lady at the surgeons office said that the Cigna I have rarely denies claims. There is a Dr to Dr call tomorrow between my surgeon and the Med Director so hopefully all will work out. I am praying.. Stressed but praying.

Share this post


Link to post
Share on other sites

So Cigna approved me today for my surgery on Tuesday!!! My representative at the surgeons office said the doctors didn't even talk. She ironed everything out the the med director herself! I am sooooo excited and now so nervous! Thank you everyone for your advise and support.

Share this post


Link to post
Share on other sites

@@Chair1311, Oh nooooooooo!!! That's horrible, I'm so sorry! Keep us posted! I know it's only been 2 days since they submitted, but I feel like calling Cigna today anyway and seeing if I even have a case # or something I can track. I HATE the waiting game!

I have Cigna as well and as of today I have been denied twice. My procedure is set for the 23rd and I have been on pins and needles waiting for a response for the second denial. The lady at the surgeons office said that the Cigna I have rarely denies claims. There is a Dr to Dr call tomorrow between my surgeon and the Med Director so hopefully all will work out. I am praying.. Stressed but praying.

Call Call Call!!! You have to be on top of them. It took the threat of a Dr to Dr call to get me approved today. Get your surgeons office involved also. Good luck!

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now

  • Trending Products

  • Trending Topics

  • Recent Status Updates

    • vsg.with.sharon

      Hey everyone!
      I’m new here! Looking for some friends! 🥰
      · 0 replies
      1. This update has no replies.
    • LeighaTR

      Four days post surgery. I am sipping as fast as I can and getting NO WHERE near the goal of 60 - 80 grams of protein or the 64 oz of liquids. I just feel FULL. I don't know if it can still be the gas build up (I would think by now that would be gone) but it is a struggle to drink. And so far I have not had the nausea or spasms and don't want to wander into that territory by pushing too hard with liquids. I about passed out today as it was my most "strenuous" day. Went from second story to basement for shower and I was sure I was going to pass out. Looking back on my last few days I have had a total of less than 1000 calories. Am I just not getting enough nourishment in me? Once again a friday where I can't get ahold of the doc until Monday rolls back around so I am hoping maybe someone here has some experience on how to keep energy going. I do have fibromyalgia too and that may be where some added fatigue comes into play. How did you all fair with the goals the week after surgery?
      · 0 replies
      1. This update has no replies.
    • Doughgurl

      2 days until I fly out to San Diego to have my Bypass Surg. in Tiajuana Mexico. Not gonna lie, the nerves are starting to surface. I don't fear the surgery itself, or the fact that I'm traveling alone, but its the aftermath that I'm stressing about the most, after this 8 week wait. I'm excited to finally be here, but I am really dreading the post surgical chapter. I know its going to be tough, real tough and I think I'm just in my head to much now that the day i here. Wish me luck, Hopefully I'm one of the lucky ones, and everything goes smoothly. Cant wait to give an exciting update,. If there is anyone else have a June bypass or even a recent one, Id love to have someone to compare war stories with. Also, anyone near San Antonio Tx? See ya soon with the future me. 💜
      · 3 replies
      1. Phil Penn

        Good Luck this procedure is well worth it I am down to 249.6 lb please continue with the process..

      2. Selina333

        I'm in Houston so kind of near you and had the sleeve in Dec. Down 61 lbs. Feeling better. Was definitely worth it. I hope the everything is going well for you. Update us when you can!

      3. Doughgurl

        I am back home after my bypass surgery in Tiajuana. I'm post op day 4. Everything went great! I guess I'm one of the lucky ones who have not encountered much pain at all, no nausea thus far and I'm having no problem keeping down broths and water. Thank you for your well wishes. I cant wait to keep up this journey and have a chance at better health and simply better quality of life. I know there will be bumps in the road ahead, and everything won't be peaches and cream, but at least I have a great start so far. 😍

    • LeighaTR

      I am new here today... and only two weeks out from my sleeve surgery on the 23rd. I am amazed I have kept my calories down to 467 today so far... that leaves me almost 750 left for dinner and maybe a snack. This is going to be tough for two weeks... but I have to believe I can do it!
      · 0 replies
      1. This update has no replies.
    • Doughgurl

      Hey everyone. I'm new here so I thought I should introduce myself. I am 53y/o and am scheduled for Gastric Bypass on June 25th, 2025. I'm located in San Antonio, Texas. I will be having my surgery in Tiajuana Mexico. I've wanted this for years, but I always had insurance where bariatric procedures were excluded. Finally I am able to afford to pay out of pocket.  I can't wait to get started, and I hope I'm prepared for the initial period of "hell". I know what I have signed up for, but I'm sure the good to come will out way the temporary period of discomfort and feelings of regret. I'd love to find people to talk to who have been through the same procedure or experience before. So I look forward to meeting you all. Hope you have a great week!
      · 2 replies
      1. Selina333

        I'm so happy for you! You are about to change your life. I was so glad to get the sleeve done in Dec. I didn't have feelings of regret overall. And I'm down almost 60 lbs. I do feel a little sad at restaurants. I can barely eat half a kid's meal. I get adults meals often because kid ones don't have the same offerings at times. Then I feel obligated to eat on that until it's gone and that can be days. So the restaurant thing isn't great for me. All the rest is fine by me! I love feeling full with very little. I do wish I could drink when eating. And will sip at the end. Just a strong habit to stop. But I'm working on it! You will do fine! Just keep focused on your desire to be different. Not better or worse. But different. I am happy both ways but my low back doesn't like me that heavy. So I listened (also my feet!). LOL! Update us on your journey! I'm not far from you. I'm in Houston. Good luck and I hope it all goes smoothly! Would love to see pics of the town you go to for this. I've never been there. Neat you will be traveling for this! Enjoy the journey. Take it one day at a time. Sometimes a few hours at a time. Follow all recommendations as best you can. 💗

      2. Doughgurl

        Thank you so much for your well wishes. I am hoping that everything goes easy for me as well. We don't eat out much as it is, so it wont be too bad in that department. Thankfully. Also, I hear you regarding your back and feet!! I'd like to add knees to the list. Killing me as we speak! I'm only 5' so the weight has to go. Too short to carry all this weight. Menopause really did a doosey on me. (😶lol) My daughter also lives in Houston. with her Husband and my 5 grand-littles. I grew up in Beaumont, so I know Houston well, I will be sure to keep in touch and update you on my journey. I may need some advice in the future, or just motivation. Thank You so much for reaching out, I was hoping to connect with someone in the community. I really appreciate it. 💜

  • Recent Topics

  • Hot Products

  • Sign Up For
    Our Newsletter

    Follow us for the latest news
    and special product offers!
  • Together, we have lost...
      lbs

    PatchAid Vitamin Patches

    ×