Waiting and Worried!

Thread Starter  

I have completed all of Cigna's requirements and Lap Band is covered on my policy. My surgeon's office sent off the paperwork for approval just before Christmas. Cigna has until Fri 2/2 to respond - 30 business days. I called today (my 5th call this month) and it is being 'reviewed by a Medical MD" since 1/24. Most days I have the attitute that what is meant for me won't go by me and other days I'm happy there is the appeal process in case I need to use it. But today I'm worried... Is this a good thing that a Medical MD is reviewing my case?

Don't worry! As long as you meet the requirements, and kept all your appointments there shouldnt be a reason to deny. I have cigna and I was lucky I got approval in 1 day. I'm sure youll be approved soon!

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:kiss2: MISSY

Thread Starter  

Thanks Missy22! It's really getting to me today - my patience has run out :-)

I had a medical review and I got approval. I think its a good thing. I have First Choice through Washington Teamsters and was supposed to have 12 months medically supervised diet and exercise and I was never asked to show it. I had about 6 months in and had been dieting and exercising for ever but nothing that showed I went in once a month for that reason when I started the process. I was going in once a month as I was having my letters written and getting my testing done. I fully expected to have to appeal and I didn't. Sometimes they surprise you! Good Luck!

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Renee
H/C/G
285/171/155
Banded 1/12/07
82.75 inches lost

Shelby, I am in the same boat as you. I also have Cigna and am waiting on approval. Its all I can think about. In fact I have dreams about it!!! I have done everything they asked, so all I can do is hope that is enough.
Kathy

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Banded 2/28/07 by Dr. Frank Felts
293/278/190/155
highest/surgery day/current/goal

Thread Starter  

Thanks for the support! It truly does help. Kathyy68 - I had a dream about Cigna last night -- too funny! I just wish I could remember how it ended :-) Good Luck to you!

Thread Starter  

I just called Cigna and I've been denied.

Was actually denied on 1/23 - of course I've called everyday since 1/22 and this is the first I'm hearing of a denial. Seems I don't have enough health issues even thought my BMI is 43 and something about my 6 month doctors care paperwork. I'll have to wait for the letter (which will be sent tomorrow) because the gal I was talking with was annoying me! I don't get it!! My insurance covers BMI over 40 with no health issues (can't think of what it's called at the moment). I have a list of stuff but I don't have diabetes, heart condition, high blood pressure, sleep apnea, etc. I can't believe this. Ok... next... I'm appealing! Wish me luck! I'm gotta go cry now...

I am so sorry. Cry and then get pissed and appeal. Good luck.

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Renee
H/C/G
285/171/155
Banded 1/12/07
82.75 inches lost

I bet you will be able to win an appeal. Maybe you should contact one of the lawyers that specialize in this type of thing, to assist in your appeal?

With a BMI of 43, I find it hard to believe you have no co-morbidites or health complications! No joint pain (knees)? Back pain? High cholesterol? PCOS?

Sounds like you have a problem with the 6 month supervised diet too. Do you have records of visiting a doctor once per month for 6 months straight? I've heard people say they missed (as little as) 1 week and there was a 5 week gap in doctor visits ... that got them denied.

I've got my fingers crossed for you!!

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Dr. Geiss - LI, NY - Banded 8/27/07
APS 10cc Band (placed with .5cc)
Fills: 11/5/07 ... 2cc

Thread Starter  

I went to my PCP every month for 6 months and she wrote 2 letters for me which I also submitted. Ihave complete support of my PCP. When I think of co-morbidites I think of diabetes, sleep apnea, etc. I do have joint pain (knees), bad back, swollen ankles, high cholestrol which was also noted in the paperwork submitted to Cigna. My surgeons office said there is a lawyer she could refer me too. Once I have the denial letter in my hand and also in the surgeons insurance coordinators hand - we'll get a game plan. But this I know for sure - I have met all Cigna's requirements - my policy covers the surgery - I will appeal. I just feel really down now - I'm not at the pissed stage yet but I"ll get there soon :-) Thanks for all your support!

Hey everyone new to the Lap Band chat .....and loving it.... just check with the doctor...apparently (I don't understand how all this works) they have submitted to my insurance (UHC CHOICE PLUS) The nurse told me that they usually request a letter from the doctor stating the Lap Band for medical reasons...they have not requested that so far....So she told me that it might be another 3 weeks until I hear something??? Does anyone know what this means for me??? I hope this is good news so far not getting turned down yet..

Shelby, I had a little of the same problem. 1st I was denied because I did not have 6 mths of documented diet, then I was denied because I did not have life threatening co-morbidities. Through my doctors office, I was put in touch with Obesity Law, (Walter Lindstrome) There is a program that will pay the attorney fees for your appeal. But we found out through this process that after a time period, (don't know how long) you are no longer allowed to appeal; therefore, I had to re-submit my info to insurance and now am waiting for my denial letter so we can appeal in THEIR time period. (Choosing my battles) If you have not already taken steps, get on line and get the # (I don't have it immediately with me) and contact the agency to see if you qualify for this program. What do you have to lose? Luck to you!

PJ

Wow, I'm still waiting from my insurance too and they are driving me stark raving MAD!
Argggh!

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Desiree "Desi"
Carson Liu, M.D., F.A.C.S., UHC Insurance
Surgery Date March 12, 2007
2nd fill July 27, 2007

"I CAN do ALL things through Christ who STRENGTHENS me!!! "
Philippians 4:13

My Dr's office said Cigna has a 6-mos medically-supervised wt-loss program requirement prior to approving surgery. I'm bummed out about it, but I've "weighted" 45+ years (LOL), so 6 mos longer shouldn't be too bad. yeah right. :cry :phanvan

Let me see if I get the concept. If you don't succeed at the 6 month diet will you get denied for being noncompliant? If you do succeed, will you be proving that you don't need the band to lose weight?

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BetsyJane
Yep. Kissing my pet deer, John Deer.
10/25/06 $100.00 1st mtg Dr. Spivak.
11/13/06 $15,000.00 Banded! 10cm/5cc band.
12/11/06 Fill 1: 1.6cc 1/12/07 Fill 2: Total 2.0cc
1/30/07 Fill 3: Total 3.0cc-Working! Osteoporosis gone.
3/07 Pouch dilation-->liquids 3 days & beh.chgs. Diabetes gone.
5/07 1/2 way home! 9/07 GERD-->11/13 minus .3cc!