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Hello All,
I got my blood work results back today and it turns out I'm healthy as a horse. I don't see how that's possible because I'm morbidly obese. I'm 5'8" 320lbs. With a BMI of 48.7....does anyone know if I have a shot of getting approved for the gastric sleeve through Cigna HMO. They do cover the surgery but I'm afraid I won't get approved since I'm "healthy". Thanks!
I was 5'6 and 252 lbs. No comorbidities at all (although I tried really hard to find some!) I have Anthem (blue cross/blue shield HMO) and I got approved just on my weight alone. My patient advocate made it her mission to keep me on track so I got the approval. I was only allowed to lose 5 lbs over the 6 month pre-op diet phase, otherwise I wouldn't have qualified for it anymore becuase my bmi would be too low. And per the insurance guidelines, I HAD to lose over those six months. YOU KNOW HOW HARD IT IS FOR A FAT PERSON TO BABYSIT 5 MEASLY POUNDS FOR SIX MONTHS?!?! psssh.... I could gain/lose that kind of weight in a day! I had to lose one lb. per month. But I did it, and approval came with no issues. Do you have a patient advocate at the doc's?
Sending all kinds of good vibes your way - hope your approval comes easily for you!
Im 5'7 & 389 @my peak im 339 now and only.thing i have is hi blood pressure dr said he cnt understand i lauf cause i am very active but im a snack.. Dont worry abt approval if u have a gud doc thats supportive he' know wat to do to fet me approved..my appoint was on the 20 on the 28 iwas schedule gor surgery fornov 9 and had.all my test set up all i had to do was go... Gud luck keep us posted..
Jewel,
Thank you so much! Honestly I don't know if I have a patient advocate at my dr's office. I am still waiting to get a refferal from my Dr. so I can go see the gastric sleeve doctor. I'm almost positive that she will give me that refferal but I don't know when that will be. Initially when I asked her for the refferal she stated to me that she has refferred a lot of her patients to this particular doctor and that she knows all the documentation she would need to refer me to him. I just emailed her last night to ask her for my blood work results and to see when I could get that refferel. She only sent me the lab results but didn't mention the referrel. I'm frusterated :o(
If they make me lose 5 pnds. in 6 months, like you said I can do that in a day or two too, LOL!! I hope they don't make me "diet" for that long. I just want the surgery so I can go on with my life.
You look awesome by the way!! Thanks for the reply!! Glad I found this forum :o)
That's so awesome! Thanks a lot for the feedback and congrats on your approval!!
Being morbidly obese is a morbidity - while we can have great labs (all I had was sleep apnea), just being that large is a danger in itself to our joints, muscles, feet. And I'm not aware of your age but if you are younger, great, you caught it before this. Somehow all of a sudden being larger catches up to you in your mid 40s, then everything goes to heck.
I don't know Cigna's rules but some ins insist on Centers of Excellence so you might want to check with Cigna and see what they will want so you can start the process neat and clean from the start. RE: the referral, could your doc have just put it through the system and is just expecting you to call the surgeon? That's how mine works things...
The surgeons office will go over the needs of your ins with you as well and what you'll need to do pre-op, like psych (important), PT, Cardio, Labs, Xrays, any classes and if you need to drop lbs before surgery. My surgeon at a COE had rules I had to drop 10% of my excess weight (20 lbs for me) before I could even meet her, I met with the bariatric coordinator at the hosp before that. Also my ins required 6 mo of trying with my doc or on my own so I had my weight watchers log in book, my online ww from the year before and my ATkins online membership. I had no trouble. Start to surgery I got it all in within 3.5 months. There's a reason there is a process, because we got larger for a reason. If we don't deal with the emotional and exercise component, we have a better chance of regain later when we can eat more. So while I understand and sympathize you want to get it done quick, there's good reason to go through the process :)
Congrats on taking the first step to better health!
Grace,
You're right there is a reason for us all to go through the process. I just hate to wait! I will call the surgical center tomorrow to see if they might of recieved my doctors refferal. She did say she was going to put it in the "system". I'm 35yrs old and I have always been overweight. My lower back hurts so much when I lay down. I get a horrible pinch in my lower back when I turn over in bed.... I'm thinking I should go do a sleep study because my husband has told me that I do stop breathing at night. I also snore really loud, lol. Thanks a lot for your input!! Congrats on your journey to a better you :)
Most insurances follow the same guidelines BMI greater than 40 with no comorbidities or greater than 35 with. At BMI of 48 they should approve you. I think they want you to stay healthy and will do the surgery as a preventative. But my insurance also said it had to be medically necessary which puts that same question in my head. I do have high blood pressure and cholesterol but it is well controlled with meds. I go back to my surgeon today and will find out hopefully when I will or if I am having my surgery. Best of luck on your weight loss journey.
A suggestion would be to call your insurance company and ask for YOUR policy exactly what is needed. You need to know this as some doc office are so busy they push you in to what is normally done. EVERY policy is diffent just because it is XYZ does not mean it is the same policy as you. This is very important to know what you have to do so you dont spend extra money and know exactly what needs to be done. PS I was healthy too just fat! =/
I weighed 325 with no medical issues and I have CIGNA insurance too. They denied my doctor's first request for the surgery because my general practitioner said I would be a GOOD candidate for the surgery and not that it was MEDICALLY NECESSARY so we had to appeal it,but once we got the letter from GP stating it was medically necessary they approved it the second time.
I have GIGNA insurance and was required to do a 6 month pre-op diet with a certified dietician and my doctor.Quote:
Originally Posted by Mona
I am also a 35 yr old female with Cigna PPO. They approved me even though I am "healthy as a horse" - just fat. My current weight is 275 at 5'5". Since I have a failed band I didn't need to do 6 more months of nutrition & diet. I was approved and got my surgery date for this Friday.
I asked my doctor for a referral to Dr. Peter LaPort's office at the OC Center for Obesity (Fountain Valley, CA) about a month ago. I think she said she had to go through my insurance first (never heard of this before). Anyways I finally got a call from Dr. Laports office today and I have an appointment at their offices in 2 weeks. They told me that I will be there for 3 hours. Not sure what I will be doing there for 3 hours, anyone know? I was at work when I got the call so I couldn't ask too many questions. I hope this is a good sign :D
Thank you all soooo much for your feedback and kind words!!
@Tesserae
Congrats!! Hope everything turns out great for you this Friday :)
Thank you all very much for your feedback ;)