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

Recommended Posts

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! :)

Share this post


Link to post
Share on other sites

That was fast. Congrats!

Share this post


Link to post
Share on other sites

Yay! Enjoy the ride!

Share this post


Link to post
Share on other sites

Congratulations!

Share this post


Link to post
Share on other sites

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..

Share this post


Link to post
Share on other sites

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

Share this post


Link to post
Share on other sites

Congratulations 🎉🎊🍾🎈

Share this post


Link to post
Share on other sites

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!👈👸👉

Share this post


Link to post
Share on other sites

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!

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

    • Prdgrdma

      So I guess after gastric bypass surgery, I cant eat flock chips because they are fried???  They sell them on here so I thought I could have them. So high in protein and no carbs.  They don't bother me at all.  Help. 
      · 1 reply
      1. NickelChip

        It's possible for a very high fat meal to cause dumping in some (30% or so) gastric bypass patients, although it's more likely to be triggered by high sugar, or by the high fat/high sugar combo (think ice cream, donuts). Dietitians will tell you to never do anything that isn't 100% healthy ever again. Realistically, you should aim for a good balance of protein, carbs, and fat each day. Should you eat fried foods every day? No. Is it possible they will make you sick? Maybe. Is it okay to eat some to see what happens and have them for a treat every now and again? Yes.

    • NovelTee

      I'm not at all hungry on this liquid pre-op diet, but I miss the sensation of chewing. It's been about two weeks––surgery is in two days––and I can't imagine how I'll feel a couple of weeks post-op. Tonight, I randomly stumbled upon a mukbang channel on YouTube, and it was strangely soothing... is it just me, or is this a thing? 
      · 1 reply
      1. NickelChip

        I actually watched cooking shows during my pre-op, like Great British Baking Show. It was a little bizarre, but didn't make me hungry. I think it was also soothing in a way.

    • Clueless_girl

      How do you figure out what your ideal weight should be? I've had a figure in my head for years, but after 3 mths of recovery I'm already almost there. So maybe my goal should be lower?
      · 3 replies
      1. NickelChip

        Well, there is actually a formula for "Ideal Body Weight" and you can use a calculator to figure it out for you. This one also does an adjusted weight for a person who starts out overweight or obese. https://www.mdcalc.com/calc/68/ideal-body-weight-adjusted-body-weight

        I would use that as a starting point, and then just see how you feel as you lose. How you look and feel is more important than a number.

      2. Clueless_girl

        I did find different calculators but I couldn't find any that accounted for body frame. But you're right, it is just a number. It was just disheartening to see that although I lost 60% of my excess weight, it's still not in the "normal/healthy" range..

      3. NickelChip

        I think it's important to remember that the weight charts and BMI ranges were developed a very long time ago and only intended to be applied to people who have never been overweight or obese. Those numbers aren't for us. When you are larger, especially for a long time, your body develops extra bone to support the weight. Your organs get a little bigger to handle the extra mass. Your entire infrastructure increases so you can support and function with the extra weight. That doesn't all go away just because you burn off the excess fat. If you still had a pair of jeans from your skinniest point in life and then lost weight to get to the exact number on the scale you were when those jeans fit you, chances are they would be a little baggy now because you would actually be thinner than you were, even though the scale and the BMI chart disagree. When in doubt, listen to the jeans, not the scale!

    • Aunty Mamo

      Tomorrow marks two weeks since surgery day and while I'm feeling remarkably well and going about just about every normal activity, I did wind up with a surface abscess on on of my incision sights and was put on an antibiotic that made me so impacted that it took me more than two hours to eliminate yesterday and scared the hell out of me. Now there's Miralax in all my beverages that aren't Smooth Move tea. I cannot experience that again. I shouldn't have to take Ativan to go to the lady's. I really looking forward to my body getting with the program again. 
      I'm in day three of the "puree" stage of eating and despite the strange textures, all of the savory flavors seem decadent. 
      I timed this surgery so that I'd be recovering during my spring break. That was a good plan. Today is a state holiday and the final day of break. I feel really strong to return to school tomorrow. 
      · 0 replies
      1. This update has no replies.
    • BeanitoDiego

      Now that I'm in maintenance mode, I'm getting a into a routine for my meals. Every day, I start out with 8-16 ounces of water, and then a proffee, which I have come to look forward to even the night before. My proffees are simply a black coffee with a protein powder added. There are three products that I cycle through: Premier Vanilla, Orgain Vanilla, and Dymatize Vanilla.
      For second breakfast on workdays, I will have a low-fat yogurt with two tablespoons of PBFit and two teaspoons of no sugar added dried cherries. I will have ingested 35-45 grams of protein at this point between the two breakfasts, with 250-285 calories, and about 20 carbs.
      For second breakfast on non-workdays, I will prepare two servings of plain, instant oatmeal with a tablespoon of an olive oil-based spread. This means I will have had 34 grams of protein, 365 calories, and 38 carbs. Non-workdays are when I am being very active with training sessions, so I allow myself more carbohydrate fuel.
      Snacks on any day are always mixed nuts, even when I am travelling. I will have 0.2 cups of a blend that I make myself. It consists of dry roasted peanuts, cashews, pumpkin seeds, sunflower seeds, pistachios, and Brazil nuts. This is 5 grams of protein, 163 calories, and 7 carbs.
      Breakfast and snacks have been the easiest to nail down. Lunch and dinner have more variables, and I prepare enough for leftovers. I concentrate on protein first, and then add vegetables. Typically tempeh, tofu, or Field Roast products with roasted or sautéed vegetables. Today, I will be eating leftovers from last night. Two ounces of tempeh with four ounces of roasted vegetables that consist of red and yellow sweet peppers, sweet potatoes, small purple potatoes, zucchini, and carrots. I will add a tablespoon of olive oil-based spread, break up 3 walnuts to sprinkle of top, and garnish with two tablespoons of grated Parmesan cheese. This particular meal will be 19 grams of protein, 377 calories, and 28 grams of carbs. Bear in mind that I do eat more carbs when I am not working, and I focus on ingesting healthy carbs instead of breads/crackers/chips/crisps.
      It's a helluva journey and I'm thankful to be on it!
       
      · 0 replies
      1. This update has no replies.
  • 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

    ×