Looks Like it's gonna be AWHILE - ThinnerTimes

Melody · 08-22-2004, 07:02 PM

Hello everyone,

Well I was denied by Cigna last week and had an appointment with Dr. Callery this past Thursday. He wasn't aware that I had been denied yet. He was also pretty upset to see them denying it when it is medically necessary. Looks like I have to talk with my PCP and see what he can do and possibly start on the 26 weeks weight loss attempt. You'd think that all the attempts in the past 20 years would be enough to show them that I haven't been able to do this on my own, but because i haven't had a "medically supervised" weight loss attempt that was 26 consecutive weeks in the past couple years they are denying me. This is very frustrating, but I know that everything happens for a reason and this is just a bump in the road. If any of you have dealt with Cigna PPO or have any other suggestions on what I should do at this point I would love to hear from you. Another option would be to sign up with HMO when open enrollment comes up in October, but still I don't know for sure how they are on approving the surgery. I believe it would be Pacificare. Anyone had them either?

Thanks everyone.. wish i was on my way to the "other side" like all of you.

Melody

1473 · 08-22-2004, 07:12 PM

Melody,

I have Pacific Care, I will find out when mine goes through. Everything is turned in and now its Dr. Callerys turn, then insur.. I will let you know, but Pacific
care alway put through everything I asked for with no problems and all ways asks me to feel out a survey on how their are serving their people to do what they can to help the most. So I'm really praying that all goes well for this surgury to.

Melody · 08-22-2004, 07:14 PM

Thank you very much. I would be interested in knowing your results. I thought everything was going smoothly for me until this denial. Good luck with your approval.. all my best! I just keep praying.. Gods plan for me is the best plan and what is meant to be will be. Thanks again!

Melody

1473 · 08-22-2004, 07:24 PM

Melody,

I pray for you to. When I find out I'll sign in and tell you because I know it's hard to wait for news. You deserve what you need, God knows and always hears your crys, it just takes waiting and thats hard. I still would do what they want till things goes through. For one thing it will be put on your record that you tried and that good for you on your part. Love ya

Bigbaldbuddie · 08-23-2004, 12:12 AM

I have Pacificare and have had no problems at all. I would reccommend them.

I am with Sharp Community Medical Group through Pacificare.

bridgetgirl · 08-23-2004, 09:34 AM

Just be patient sugar pea... it WILL happen. The time is going to pass anyways... we're here for ya! Keep your head up.

lealphachienne · 08-23-2004, 09:42 AM

When my hubby had to go through it 2 odd years ago, he was denied by Cigna HMO. They were tough, for the same reason, even though my husband was 454 lbs and has had medical weight loss attempts since he was 9 years old! As with you, he hadn't had anything for the previous two years before he tried for approval. Fortunately, we had 2 insurances, one from each of our jobs. Blue Cross HMO approved him a month after he was denied by Cigna.

HapBird · 08-23-2004, 12:11 PM

In researching this surgery, I've read that sometimes insurance companies will deny patients on their first try, hoping either that they will give up (saving the ins. co. money short-term, but certainly not long-term), or that they will actually "succeed" on yet another weight loss regimen of some sort under medical supervision. Apparently there are statistics supporting the idea that about 5% of people can lose large amounts of weight and keep it off for a long time without surgical intervention, and the insurance company may just be hoping to find one of those. Chances are slim, though, I'd think, among the prospective clientele of bariatric surgeons - most of us would have discovered our ability to be in that 5% a heck of a long time ago.

I bought a book on the surgery which addresses what to do with denials, and it contains some sample letters with advice on how to handle challenging a denial. It's called "The Doctor's Guide to Weight Loss Surgery" by Louis Flancbaum, MD. I got it at Amazon.com for about $10 (used, but copy is in perfect condition...)

A Google search for "weight loss surgery denial letter" brings up some more samples you can look at for ideas. Get an appeal letter from Dr. Callery, your PCP, and write one yourself.

This is my plan in the event my insurance denies me first time around. I'm training myself to expect this so it won't be such a disappointment when/if it happens. They've already denied me on a couple of smaller matters, so I won't be surprised if they turn me down on this... but if they do, they'll be hearing from me!

Hang in there!!!!!!

Melody · 08-24-2004, 01:34 PM

Thank you everyone for all of your input. I am going to make an appt. with my PCP and see what he has to say and then I'll go from there. I will keep you all posted. I want to stay involved here too, hope y'all don't mind. Its just great hearing all of your successes, struggles, etc.. I figure at worst i will just have to do the 26 weeks and then appeal with the insurance. Ultimately God is in control and maybe my PCP will be able to write something up.

Thanks again! You are all great!

Melody
(pre-op Dr. Callery)

watergirl · 08-24-2004, 05:59 PM

My heart is aching for you. I know you'll be with us soon. Try to think positively, it's just not the right time for you now. My thoughts and prayers are with you.