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Re: Cigna PPO

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I couldn't say if they'll go for it. I think they are going to

chalenge you though. A BMI of 45 is not very high, and you don't have

any serious co-morbidities.

Also, the pain of recovery doesn't get a lot of press here, so I will

share my observations. This whole process has been extraordinarily

painful and uncomfortable. Even with a BMI of 59 and raging

co-morbidities, in the past month I have seriously questioned my

decision to do it. It's easy to think of the operation as one neat

little BPD/DS package, but actually the partial gastrectomy is quite

horrific. The pictures don't do it justice. They cut away 9/10ths of

your stomach, leaving a tiny " tube " from esophagus to pylorus. And

unlike the intestines, the stomach is nerve-filled and

oh-so-sensitive. It takes a long time to heal. I am over a month into

it, and my main daily concern is still walking on tender-hooks to

avoid agravating my stomach. There is a constant overall nausea which

sometimes flares into pain. There are a number of other tough aspects

to the adjustments you must make, but I would get cramps writing about

them all.

And this is if all goes well. One of the things that terrifies me now,

is the possibility of a complication that will require another

operation. I would have to go through the whole damn thing over again!

This would include leaks, herniation, etc. These things are NOT RARE!

Aside from a long and uncomfortable recovery, this operation also

requires life-long nutritional risk, and potential struggle with

insurance over payment for special expensive vitamin compounding,

which most don't want to cover. I just had to have mine filled, and

it's going to cost over $200 per month.

I did not have any idea how tough recovery would be, and I wish I had

been better prepared. Since my life was truly at stake, I suppose I

would have done it anyway, but if there was a way I could have put

this off, I would have, knowing what I know now. If my life was not at

staks, there's no way I'd have chosen this torment. And my story is a

walk in the park compared to people who have had leaks and other

common complications.

-Sk

xxxxxx wrote:

>

> Re: Cigna PPO

>

> > Yes, I have Cigna PPO. You have to persist. Keep applying,

appealing,

> > calling, etc. (Be nice.) I got the feeling they try to weed out

all

but

> > those who are highly motivated and persistent. Fortunately also,

my

> > doctor and his staff took the fight to Cigna and kept the pressure

up.

> > All in all, it took about 3 months for me.

> >

> > Focus on MEDICAL NECESSITY. Specifically list as many

co-morbidities

as

> > possible on the letter of medical necessity, e.g. diabetes,

recently

> > diagnosed sleep apnea, hypertension, high BMI (super morbid

obesity),

> > etc. You have to build a very convincing medical case showing

compelling

> > medical necessity.

>

> You're confirming a lot of what I've heard before...I appreciate

that,

even

> though I wish it was better news. :)

>

> I worry that my co-morbs aren't enough...my BMI is 45 (while high,

it's

not

> 60), i have high cholesterol, high triglycerides, possible sleep

apnea

> (sleep study is pending...Cigna is giving the sleep study people a

hard

time

> about preapproval), and borderline high blood pressure. Diabetes

and

> hypertension are in my family history. Do you think that's enough??

Sigh.

>

> I promise I'll be persistent!! :)

>

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> > I did not have any idea how tough recovery would be, and I wish I

had

> been better prepared. Since my life was truly at stake, I suppose I

> would have done it anyway, but if there was a way I could have put

> this off, I would have, knowing what I know now. If my life was not

at

> staks, there's no way I'd have chosen this torment. And my story is

a

> walk in the park compared to people who have had leaks and other

> common complications.

>

> -Sk

>

> , I'm so sorry this has been so tough on you. Hang in there,

it does get better. The first month is the toughest, then gradually

things improve. I too doubted my decision in the first few weeks..

Be Well, Meli

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