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Thread: Denied

  1. #1
    Gastric Sleeve Member Kristi7928's Avatar
    I have had a gastric sleeve.
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    Kristi
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    Default Denied

    Got the letter from Cigna today denying my surgery. I do have Medicaid as a secondary so I am hoping that is a backup option. The billing lady at my first appointment said I was covered - I would just be responsible for my deductible. I have emailed the nurse and see what my options are.

    If it's not good news - what are the steps to go to Mexico?

    Heartbroken. I was so ready for a surgery date.
    HW: 245.4 SW: 243 CW: 160 GW: 135


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  3. Gastric Sleeve Surgery With Weight Loss Agents
  4. #2
    Gastric Sleeve Member Stacey03's Avatar
    I have had a gastric sleeve.
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    Default Re: Denied

    I'm so sorry to hear that kristi, I'm sure there must be another way. Keep fighting x


  5. #3
    Gastric Sleeve Member MikeMo's Avatar
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    Default Re: Denied

    See if you can figure out why they denied you - then appeal if there's any way. My insurance flat out does not cover bariatric surgery so I am "self paying" at a clinic in the DFW metro area; they submit what they can for peripheral services but I'm out around $8,500. Figure it's a survivable amount for a major life improvement. Insurance companies can be a real pain, and if they don't categorically deny bariatric procedures maybe there's some hoop you can dive through like pre surgery diet, counseling, or something else. Good luck with your quest, just try hard not to get discouraged!



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  7. #4
    Gastric Sleeve Member Christie13's Avatar
    I have had a gastric sleeve.
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    Default Re: Denied

    I am so sorry Kristi. I hope you get approved from Medicaid. I know that is so disappointing. I am sure the Mexico sleevers will chime in with what that process is. Big hugs.



  8. #5
    Gastric Sleeve Member keightkate's Avatar
    I have not had a gastric sleeve.
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    Default Re: Denied

    I would not loose another lb if i were you until you had clear answers. I weighed in at 231 and my bmi is just 40. I am on a "3 month supervised diet" but my doctor said not to loose anything. It is tough- Heard lots of good things about Mexico and that it is actually cheaper than my deductible....



  9. Gastric Sleeve Surgery With Weight Loss Agents
  10. #6
    Gastric Sleeve Member keightkate's Avatar
    I have not had a gastric sleeve.
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    Dr. David Oliak
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    Default Re: Denied

    OMG with my insurance i'll be paying $7,500



  11. #7
    Gastric Sleeve Member terrora's Avatar
    I have had a gastric sleeve.
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    Terrie
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    Quinones
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    Default Re: Denied

    Hi there
    I had mine done in Mexico. I have never regretted it .
    The coordinator is now working with another doctor. She and her husband moved from Florida to Tijuana to work with this doctor and his staff. I would put you in contact with her.
    OR find her on Facebook. ************ MX
    My email is terrora45@yahoo.com



  12. #8
    Gastric Sleeve Member Marsh17's Avatar
    I have not had a gastric sleeve.
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    Default Re: Denied

    Is your insurance through your employer? Ask either your employer or Cigna for your Summary Plan Description (SPD) this will outline the details of your plan. This is a large document. You can go through the document and see specifically what the requirements are for this specific procedure. Ask the physicians office what documents and documentation they submitted to the insurance company on your behalf. Take the documents submitted from your physicians office and the SPD and see if you meet the requirements or see where you fell short of the requirements. Generally after receiving a denial from your insurance company you have a 1st appeal process and a 2nd appeal process. Best of luck to you!!!

  13. #9
    Gastric Sleeve Member Kristi7928's Avatar
    I have had a gastric sleeve.
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    Kristi
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    09/27/2018
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    Dr. Bradley Thaemert
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    Default Re: Denied

    Already got a message from the nurse - she said my insurance doesn’t have any bariatric benefits. She has already submitted it to Medicaid and she hopes we hear something in the next week.
    HW: 245.4 SW: 243 CW: 160 GW: 135


  14. #10
    Gastric Sleeve Member Lisa73me's Avatar
    I have had a gastric sleeve.
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    Lisa
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    Dr. Marcelo Hernandez
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    Default Re: Denied

    So sorry you got denied, don't give up!

    https://www.weightlossagents.com/



  15. #11
    Gastric Sleeve Member MikeMo's Avatar
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    Mike
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    Dr. Heath Smith
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    Default Re: Denied

    That's what happened to me - bariatric surgery excluded from my insurance plan -- total bummer. The doctor I'm going to charges $8500 in the DFW metro area for cash patients, and that covers the pretesting and surgery. Additional follow up visits are additional, but they offer a prepay discount for the four visits. For me it's a hour drive from where I live, and they do plenty of surgerys so it's pretty accessible to me. But it's a pisser -- being heavy is a health condition, and this is one of the few medically successful treatments out there. Hang in there, I feel for you. It's a pain in the butt to be sure.



  16. #12
    Gastric Sleeve Member meme3's Avatar
    I have not had a gastric sleeve.
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    03/05/2018
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    Dr. Mario Almanza
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    Default Re: Denied

    For me, going to Mexico for the surgery, including the hotel bill (for a friend to travel with me) and my airfare is still cheaper than the deductible would be on my insurance. Plus I don't have to jump through hoops with the insurance company by going to doctors for a year to determine I needed the surgery after all. I know my body, I know what I am doing to my body eating the way I did for so many years and I know that I can not accomplish my goals without the help of surgery. I wish you the best in whatever decision that you make.



  17. #13
    Gastric Sleeve Member AnnieG's Avatar
    I have had a gastric sleeve.
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    Annie
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    Default Re: Denied

    Quote Originally Posted by Kristi7928 View Post
    Got the letter from Cigna today denying my surgery. I do have Medicaid as a secondary so I am hoping that is a backup option. The billing lady at my first appointment said I was covered - I would just be responsible for my deductible. I have emailed the nurse and see what my options are.

    If it's not good news - what are the steps to go to Mexico?

    Heartbroken. I was so ready for a surgery date.
    Kristi, if you decide to appeal, and need help, it's part of what I did while I worked (although in mental health). I've had lots of success with getting things overturned, including disability. Just PM me if you need help, and since I am still a mandated reporter, HIPAA applies

    I was self pay...$13,100 but well worth it in terms of my health. I am blessed my husband felt we could invest that much, but the per price pound, OMG.
    [I]HW: 240 lbs SW: 199 lbs GW: 140 lbs

    1 MO = 167.0 2 MO = 156.4 3 MO = 148.4 4 MO = 140.6
    5 M) = 136.0 6 MO = 130.0
    1 YR = 122.0 2 YR = 140.00 2.5 YR = 139
    Happy with my weight; happy with my size; over-the-moon with my health!

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  19. #14
    Gastric Sleeve Member shrinkvi's Avatar
    I have had a gastric sleeve.
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    Violet
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    03/12/2018
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    A California surgeon
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    Default Re: Denied

    I'm on Cigna too and my plan has a specific section calling out wls as a non-covered benefit. I feel your pain, but at least you have Medicaid. Good luck there! I'm paying $21K out of pocket for my surgery.

    - My easy low-calorie recipes for weight loss
    - What having gastric sleeve surgery is like

  20. #15
    Gastric Sleeve Member Kristi7928's Avatar
    I have had a gastric sleeve.
    Name
    Kristi
    Surgery date
    09/27/2018
    Surgeon
    Dr. Bradley Thaemert
    Join Date
    Sep 2017
    Last Activity
    04-17-2022 02:53 PM
    Location
    Sioux Falls
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    173
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    Default Re: Denied

    Quote Originally Posted by AnnieG View Post
    Kristi, if you decide to appeal, and need help, it's part of what I did while I worked (although in mental health). I've had lots of success with getting things overturned, including disability. Just PM me if you need help, and since I am still a mandated reporter, HIPAA applies

    I was self pay...$13,100 but well worth it in terms of my health. I am blessed my husband felt we could invest that much, but the per price pound, OMG.
    Thank you! This is very kind of you to offer. I'm still hopeful for Medicaid. I have yet to hear from them. It'll be about two weeks this coming Tuesday. I'm so ready for it. And just want to get this part of my journey started. Thank you again! I'll let you know if I need some help.
    HW: 245.4 SW: 243 CW: 160 GW: 135


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