Hello from Colorado

Joined
Oct 23, 2019
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My surgery date is in November but Cigna denied my insurance since bariatric surgery isn't part of my employer plan. I was referred to the site here to reach out to Lara or Diana to discuss how to appeal.
 
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Hi and welcome!
I checked out Dr. Long's website and apparently he does what he calls "loop DS", aka SIPS/SADI and probably a few other names. This is a much newer operation than the traditional DS. It has only recently been accepted by the ASMBS. I don't know of course, whether or not he discussed and compared this variation on the DS with what most of us here consider the gold standard, which is the DS with rous-en-Y configuration.
I agree with DianaCox advise to get your EOC and let's see what bariatric surgery coverage you have, if any, and also any appeals rights you might or might not have. If your insurance is self funded, as it most likely is, your options may be very limited for getting coverage. If you can't get coverage, you might do well do again consider your options and look into a traditional (many of us would say real) DS in Mexico, where there is a very well regarded, experienced surgeon who offers the traditional DS. There are some of his post-ops here and all speak well of him and also of their experience with the hospital where he operates. The difference in price can be considerable, along with having with what many of us, including me, believe is a better operation. OTOH, if you are thrilled with your local surgeon and happy with what he's offering, go for it.
 
Dr. Long does "loop DS", aka SIPS/SADI.
I don't know of course, whether or not he discussed and compared this variation on the DS.

Yes, Dr Long is very thorough in making sure you know the various options for surgery, is careful to discuss each one with you, and ask if you have a preference. We both prefer the DS for me.

... get your EOC and let's see what bariatric surgery coverage you have, if any, and also any appeals rights you might or might not have.

I posted it in another thread. I have no surgery coverage for this, but hoping there's a loophole via appeal. I have several comorbidities and I'm hoping they'll see that it'll be cheaper for them in the long run than me having fill blown diabetes some day, and dealing with severe sleep apnea, etc :)

You might do well do again consider your options and look into a traditional DS in Mexico

Not really an option for me at the moment (my wife has mental health issues and I need to be as present as possible to assist with children) which is why I've already booked the surgery with Dr Long. Now it's just a question of whether I pay for it myself or if insurance can cover any of it.

I understand that Mexico may be cheaper, but the travel part isn't feasible.

I very much appreciate your response!
 
I'm so sorry about your wife's problems. I completely understand that, for all sorts of reasons, travel for surgery just isn't feasible for everyone.
Sadly, most employers will look only at the costs in the current quarter and not the potentially greater expense down the line, but you have nothing to lose by trying to appeal.
 

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