I Can't Believe It...

[sher0929 17]

Approved!! 🤩

My surgeon submitted paperwork to Cigna on Thursday afternoon and I received my approval Monday evening. I'm impressed with how quickly it was approved. I even received a letter yesterday stating that Cigna needed more information (it clarified that the letter was not a denial, just a request for additional records).

Here is a recap of my insurance approval process for anyone who is curious how it went:

Surgeon - Alisa Coker

Johns Hopkins Bayview

Baltimore, Maryland

SW: 192

Height: 5'0

BMI: 37.5

Procedure: Laparoscopic Sleeve Gastrectomy (aka sleeve or gastric sleeve)

Comorbidities: Diabetes, Hyperlipidemia (High Cholesterol), Hypertension (High Blood Pressure) **Worth noting, I take one medication for diabetes, and one low dose medication for hypertension. The hypertension medication I actually stated taking during this process.**

Requirements-

BMI = or >40 or = or > 35 with at least one comorbidity

3 Months of medically managed weight loss with primary care or registered nutritionist/dietitian (4 visits total - first was Dec 5th and then one each month Jan, Feb, March) **I have since read the verbiage change in Cigna's requirements and they have removed the 3 months of supervised weight loss. This may still me a requirement by your surgery team though, but it doesn't hurt to ask**

Upper Endoscopy - Standard test that checks for GERD, stomach ulcers, infections, and anatomy. This was an outpatient procedure. I was in the hospital for a total of 3 hours from arrival to departure. I was completely asleep during the procedure (they give you a top shelf iv cocktail) but recovery was much less than that of general anesthesia.

sleep Study - For sleep apnea and/or other weight related sleep disorders. Mine was an at-home test that was easy as pie. It was a wrist watch that connected to a few nodes and a sensor on your finger.

Psychological Evaluation - I went to a doctor who specializes in evaluations for bariatric surgery. It was probably the most nerve wracking of all the appointments because there's a strange looming in the air that these evals are hard to pass. **Tip - Tell the truth (your insurance will look at your medical records so if you have been treated for mental health but lie about it during your eval, they may deny you coverage) but don't unload your whole tragic life story on them. I have been treated for and hospitalized for bipolar and it didn't prevent my approval. They are basically trying to determine if you have a clear understanding of what the surgical procedure is and how your lifestyle will need to change. They want to make sure there isn't anything major that will intellectually challenged your results (major or unaddressed eating disorders, lack of understanding of the diet requirements, lack of motivation to lose weight), that you have a good support system at home, and that you are aware of aftercare requirements for life, possible complications, and after affects of weight loss on yourself and your relationships. In a nutshell, they need to know that you're aware of what you're getting yourself into, you are of sound mind, it was your decision to have surgery (not having the procedure against your will or at someone else's insistence), and you are equipped with the knowledge you need to be successful afterwards.

Nutrition Consultation - I was required to see the nutrition team at Johns Hopkins for a 90-minute appointment. We covered every aspect of the diet requirements from the two week pre-op, day before surgery, day of surgery, and each week after surgery until the 8 week mark. This appointment was very helpful. It was the most important component, in my opinion, because it really showed me exactly how my diet and lifestyle would change. I left that appointment with zero questions about how to be successful.

Letter Of Recommendation - A letter from my primary doctor (it had to be a doctor unaffiliated with the surgeon or surgeon's team) stating that I was physically able to have surgery, that I failed to maintain weight loss via medically assisted management, and that weight loss surgery was being recommended and was medically neccessary. This letter is very important as I have heard/read stories about insurance denials because the verbiage wasn't correct or one of the listed components wasn't included.

Blood Work - Usually done by primary care. This served as proof of hyperlipidemia and diabetes.

Once all of these were completed and the surgeon's coordinator received the paperwork, she compiled it into a package for review. She handed it over to a nurse on staff who double checks that everything is there and that it is in the right format with the right info. **Most surgical teams are well informed about what insurance companies look for. They will make sure your information is submitted correctly to prevent delays and denials.** Once the nurse gave her seal of approval, the coordinator submitted the precertification request to Cigna on Thursday.

Monday afternoon I received a letter that said additional information was being requested from my surgeon. I contacted Cigna to find out what additional info was needed (I was curious...and antsy!) They told me that the surgeon would receive a letter as well which would include details of the request. Well, that didn't satisfy me so I probed on asking if those details could be disclosed to me, since it is MY medical record. The Cigna rep (Charline) was extremely helpful. She contacted the precertification department for details and called me back that evening with news that I was approved. Johns Hopkins had provided the requested information pretty much immediately upon receiving the request. Low and behold, I checked my myCigna account and the black, in-progress status had transformed into the prettiest green APPROVED:)

Big props to Marie Day and the team at John's Hopkins for their attentiveness!!!

And that, my friends, is the super drawn out, nitty gritty process of getting approved for bariatric surgery via Cigna!

I know when I first set out I had a million questions so I tried to provide all of the info I always looked for but couldn't find. If you have any specific questions for me please let me know. I'm not a medical professional, this is simply info from personal experience, but I'm happy to offer peace of mind if I can!

Happy sleeving, y'all!

[GreenTealael 25,625]

💜 CONGRATULATIONS 💜

[Healthy_life2 8,330]

That was fast. Congrats!

[KCgirl061 1,533]

Yay! Enjoy the ride!

[FluffySaysForkIt! 823]

Congratulations!

[reese28 9]

Congratulations

Sent from my SM-N960U using BariatricPal mobile app

[KarenLR75 518]

Congrats! I'm curious if there are different 'flavors' of Cigna if you will. I have Cigna and just met with an in network bariatric surgeon and to my shock, despite my one year of supervised weight loss with primary doctor (length of time determined by MYSELF and knowing IF Cigna required it, I would more than meet this requirement; however, they are saying Cigna REQUIRES SIX MONTHS of visits with a nutritionist and they must be 'back to back' or you have to start all over??!!

My primary dr has been a huge fan of low carb/keto lifestyle whether you are obese or not to help patients with other health issues so over the years and before my supervised weight loss, we would trade out info on the latest trend, counting macros, why you can stall and be in highest (deep purple level of ketosis), how many ppl don't realize too much Protein can be converted to Glucose. As my weight loss slowed due to both knees now needing to be replaced (still in shock from that) and insurance only approving injections every 6 months, the difficulty I have getting around is devastating to me. WHY would they toss out the weight loss requirement and INCREASE to an unfathomable level, a requirement to see nutritionist BEFORE surgery for SIX MONTHS?!

I have been preparing to ensure that I was truly ready for this for 4 years...doing the supervised weight loss especially while battling being able to get around and working 50+ hr weeks has been difficult but doable and I was so happy I hit a weight loss of 50 lbs (mostly from last 9 months). I fully expected to see nutritionist 1 or 2 times before surgery and then again multiple times after. I know I need to see one although I will be bringing them what I've been doing and having them many any necessary adjustments.

I'm still stunned. I just found this out yesterday. Ironically both my primary and my surgeon feel that having this be such a long requirement w/o requiring the weight loss or maybe they require just a shorter period...is to discourage ppl from getting the surgery. I guess they'd rather pay my 50K to 100K annual hospital stays?

Sorry, I do want you to know that I am above thrilled for you...but so very very confused and disappointed for me. Mexico looking better & better..

[M0Mof3NC 18]

I received the Cigna notice today requesting more information from my surgeon. Praying they are on it quickly and approval is received soon!

[sweetsagi 28]

Congratulations 🎉🎊🍾🎈

[reese28 9]

Congratulations

[Frustr8 7,886]

I would say things are starting to look promising for you. Let's all pray that the surgeon phrases perfectly what they are requesting and you will be on your way to your D*a*y of Destiny! And I am excited for you in advance!👈👸👉

[KarenLR75 518]

Congrats, rlmeeks! In an abrupt turnabout, my doc's office called me while I was waiting to see my spine doctor and asked if I had gone by Quest to do my final remaining lab - this 'breath test' thing that I found out you can't have put even just 'toothpaste' in your mouth. I said no, the doc said to just get it done before my next appt with is around June 7th.

For anyone who has followed my um....slight tussle with my doc's staff about how they were interpreting Cigna's requirements....the following statement the office mgr made on the phone almost made me laugh....she said "can you please get it done ASAP as that is the only thing we are missing to push it through to your insurance"...

I was dumbfounded..and thrilled. I told them I'd get it done in the next few days.

Congrats again on the progress with the process, rlmeeks!