should I still pursue this?

kplant · 06-03-2008, 08:42 PM

I called cigna, got all of their new requirements. I have been 260 for 2 years which is slight more that 40% BMI for my 5'7 1/2" ht. I have to show that I have been this weight for 24 months. I ordered all the medical records and the only one I have that is from 18 months ago (I need to finish the 6 month dr supervised weight loss -- I actually did this last year - for 5 months so I *know* it won't count). It says I was 256 AND 5'8" which means I am 39% BMI! The other drs didn't even measure how tall I am. I have slightly elevated bp but not enough (according to cigna). Grrrr. I am in NYC so I would probably go to Fielding. Should I make an apt to discuss this with the drs or is it pretty hopeless? It is $24,000 here so there is no way I can afford it.

cathychatts · 06-03-2008, 08:48 PM

I also have Cigna and I would try it. The BMI is calculated by the surgeon and they always figure your height on the short side and weight on the high side. If you have records from 18 months showing the weight and also do the 6 months then you will qualify. The look at the weight from the date you visit the surgeon, not after the 6 months. If you did 5 months that might count.
It is worth a try. Good luck. I had figures close to yours and they approved me. My surgery is the 6th of June!

kplant · 06-03-2008, 08:54 PM

I think the surgeons I am working with seem to be great at working with insurance. I would imagine the 5'7" vs 5'8" would be easy to prove which would put me over the edge. I guess the next step is seeing the drs. The 5 month thing wasn't the only issue. I only saw the dr 4 times during that 5 months and I need to see him once a month. I am not SO concerned about that as I need 6 months anyway AND the practice of fielding has a nutritionist that works with Lap Band candidates who I would like to see. He also offers a special for 6 months (in order to satisfy ins requirements)

ssdown · 06-03-2008, 11:43 PM

I challenged the height that I was given. I have always been 5'2 1/2 and I got measured at 5'3, which made a difference. I also purposely gained some weight to qualify. I know others have place weights or coin rolls in their pockets or around their ankles to qualify! I might have done that had I thought of it! SS

kplant · 06-04-2008, 05:49 AM

I would actually need to gain 4 pounds to make it. Which is bloat + chugging water and not peeing. I think I will go after the height. What I am wondering is if they didn't measure me and I said 5'8. Oddly, I never lie about my weight but I do about my height. Came back to bite me.

cathychatts · 06-04-2008, 09:24 AM

One word of caution, with Cigna, they have a clause in their policy that says the 6 month diet cannot be at the surgeon's practice. It needs to be a separate doctor's practice. So be sure that your Primary care doctor or someone else monitors the weight, not just the WL surgeon.

When I went in for my 1st consult with the surgeon, I ate a bunch of junk for about 4 days before and wore my thickest jeans and a sweatshirt and a heavy jacket, plus I wore heavy hiking boots and didn't take them off. I also may have left my car keys and my cell phone in my pocket.

kplant · 06-04-2008, 09:28 AM

thanks Chattycathy! The surgeons had a few weightloss drs they recommended. None are related to their practice (they said that also, that it couldn't be related). Could you give me your BMI #s? Did you have a 24 month track record of being at that weight or did you not need to show this?

kplant · 06-04-2008, 09:56 AM

I mean cathychatts! Sorry! I think I was hoping you would be chatty and spill more info!

ssdown · 06-04-2008, 09:05 PM

Four pounds is only two, two pound weights!

cathychatts · 06-04-2008, 09:26 PM

Before I started the process my BMI was below 40 and was never higher. I did eat with abandon in Dec, Jan, and Feb and gained about 15 lbs. I knew it would be easier with a BMI of 40. I didn't intentionally gain the weight, I just let go of all restrains! So, of course I gained! I have several co-mobidities. Such as sleep apnea and gerd and asthma, but I knew it would be easier with the 40 BMI. I must say, the eating frenzie was good for me. I got to where I didn't want to eat! I didn't enjoy it much anymore! Who would have thunk it?

Good luck, if you have more questions, my name could easily be Chatty Cathy, Cathychatts is just more unusal and easier to get on most logins!

aculberg · 06-05-2008, 11:01 AM

Ok, so I have a question about adding a little weight to qualify. I am at that mark, just got approval from my pcm to see the surgeon. So at the first surgeon visit, would it be terrible to wear ankle weights? I mean, do they check?? I would be horrified if they did. Also, what all happens at that first appt??

Take me step by step!! lol

laurenwhite82 · 06-05-2008, 12:16 PM

So i have a question about the 24 months....how many weigh ins do you have to have to prove you were over a 40 BMI for those months?? 2, 1 for each year?? One for each month?? (Surely not) What about those of us who didnt go to the dr that much?!?

cathychatts · 06-07-2008, 10:04 AM

Hello
I was banded yesterday and feeling pretty good! So happy to be on the filp side of surgery!

As far as the weight ins for the 24 months. I think one is all that is needed. One doctor's notes of the weight. It wouldn't hurt to show a yo-yoo in weight over a few years. They look at that as the need for the band to help control your weight and that you try to diet.

Good luck! it is so worth it.

As far as the weight at the surgeon's office, they try to help you qualify. So don't mention it and they don't ask.

Good luck

laurenwhite82 · 06-07-2008, 05:02 PM

Awesome....I can do that! Glad you are feeling good and wish you the best of luck in your weight loss journey. I know Im ready to begin mine!

should I still pursue this?

should I still pursue this?

Yes, try

thanks so much for your reply

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Chatty Cathy