The Waiting Game..............

[MyChess]

Well here I am in this limbo of waiting to see if my insurance will say "Yay" or "Nay". During my consult, my doctor told me Cigna was one of the strictest and hardest to get a approval. I have done everything they asked for, but documentation isn't all there. First, the nutritionist that I was going to, is no longer at the Wellness Center/Hospital and they no longer have my chart. They say they have all of his notes on me scanned into hospital records, but after getting them, they are not all there. Second, my workout program was designed and adjusted for me for the year and half I was attending the gym through their electronic key. You just put your key in and it tells you what your exercise routine is for the day. Well, approximately 7 months ago, the computer/machine that recorded everything blew-up and there are now no records of that. I gathered as much proof as I could (i.e. print-out of check-ins, etc.), so now it is in their hands. Do I get the "thumbs-up" or do I have to start all over again..............

Deana

[Monica_Lynn]

Good luck! I don't know about Cigna but BCBS of IL is another stickler for documentation and after 2 submissions, I was approved.

[krisjoy]

I have CIGNA and they approved me in 23 hours, but I made sure I had absolutely everything there. I paid extra for an additional visit with a dietition who wrote me a letter. Is there anyway to get a hold of anyone at the place you did your diet who will write you a letter? Do you have a case manager at CIGNA? I know I had to call and request a list of things I needed for the surgery. I was really suprised when they sent me a link to a 4 page document. The case manager was a lot of help and I talked to her at least twice a month. Good luck! I about died waiting for the approval call!

[MyChess]

Well the waiting game is over, I was denied. I don't know the specifics yet, but I am very disappointed.

[jm45]

So sorry to hear you have been denied - but just don't give up - Dust yourself off and carry on!!!

[MyChess]

Well according to the surgeon's office, the only thing they denied me for was not having a consult with a dietitionist/nutritionist within the last 12 months. I only have 7 days for the doctor to have a peer w/peer phone call, after that it will have to be approached as an appeals process, which will take longer.

Well guess what, I have an appointment with a Registered Dietitionist at 9 am tomorrow. It just so happens they had a cancellation........whoohoo for me!! I can see the light at the end of the tunnel!!

Deana

[jm45]

Good for you - i will keep my fingers crossed. x

[FlowerGalTX]

Hopefully this will be resolved in a timely manner! That is awesome news about the 9 am dietician/nutritionist appt! =)

[MyChess]

thx jm.........mine are crossed too!!!

[shaminthedevil]

It has take me over 3 appeals (all denied) by the weight center, a grievence appeal by me and then finally a Peer to Peer review with my surgeon and the medical director of the Insurance co :/ All this took little over a year. I was approved immediately for the Bypass but I my Dr and I agreed that the sleeve would be better for me.

[brendadenton64]

keep fighting, them insurance companies need to release some of them funds that we as tax payers pay in to help folks...Good luck on your journey

[MyChess]

Went to the dietitionist today, which according to my denial, is all I need to do to get approved. Hopefully they will forward to the doctor and the doctor will to a peer to peer with the medical director of Cigna. Fingers crossed really hard right now!!!

[MyChess]

Well I just want to cry........................

The dietitionist just faxed over her notes from our meeting yesterday (to my doctor and to me). This is exactly what she put in the notes for the insurance company...............

Pt. states she has had previous education on weight loss and bariatric recommendations, but "fell off the wagon." Pt. discountinued her physical activity regimen and weight loss/bariatric diet plan and states only recently starting going back to the gym 2x/week. During that time, pt. states she gained some weight back. Reports weighing 285# two weeks prior, today pt. wieghs 290.2#. Pt. appears familiar with dietary recommendations from previous appts, but is currently not following: large portion sizes, skipped meals, carbonated beverages, inadequate water, high fat entrees, lack of self-montering food/beverage intake. Pt. is also not currently checking blood glucose and states last BG check was 4 months ago. Pt. currently lacks the lifestyle modifications needed for successful bariatric procedures, a f/u with dietitian may be recommended prior to scheduling surgery to determine readiness. Discussed with pt. importance of these behavior changes long-term and that bariatric surgery is likely to be unsuccessful if behavior modifications are neglected.

Now tell me.............I think she just threw me under the bus!!!!

Deana

[ckeff]

That just sucks