Sam I Am

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The day before the surgery I was remarkably calm.  I had expected that I would be very apprehensive and nervous.  I took myself to Target to buy the horrible Magnesium Citrate, but because I had limited myself to liquids over the past three days it really wasn't that bad.  Around 10pm I started to feel myself get anxious and so I took some Xanax.  (I had discussed the Xanax with the surgeon before hand and he had given it the ok. 

Up until the day before surgery I was a bit of a wreck.  I had trouble, sleeping, eating and concentrating.  My Husband kept trying to firm up holiday plans and in my mind I kept saying, I might die on Thursday.  I never expressed this to my Husband as he was freaked out enough as it was.

I went to bed pretty easily the night before surgery and didn't wake up unti my alarm went off, I had expected my sleep to be much more spotty.

I don't think my poor husband has slept for days 

Cigna Required a six month supervised diet before approving me for surgery.

I went in and saw my doctor seven times for seven consecutive months (I was told the first month would not count because that is when the doctor would give me the outline for diet and weight loss.  I kept a journal at home and shared this with my doctor.

At every appointment I showed up and told them I was there for a follow up for obesity.

I tried Meridia but could not tolerate it because it caused increased anxiety.

At every appointment they monitored my weight, blood pressure, pulse, height and respiration.  The doctor took my vitals and we talked about the progress on my diet.  It was nothing major.

I'm happy to answer additional questions for anyone struggling with this part.  I made sure that I went once each month, though sometimes the appointments were more than 30 days apart and were not always with the same doctor.

Starting thinking about WLS in November 07, when I looked into it I realized it was an exclusion on the United Healthcare policy provided to me by my employer.   When open enrollment came I got on my Husband's plan with Cigna.  I began my six months monitored diet and weight loss in January 2008.  I went to a seminar at Durham Regional on January 11th.  I got all my applications materials into Duke in mid February and my first appointment was May 21st.  I went to my first apointment with Duke, I had my psych eval and meeting with the RN.  The nutritionist was out that day so he reviewed my records and sent me something later.  I continued going to my Primary Doctor once a month every month.  We did a low fat/low calorie diet with increased exercise and I tried Meridia for three months, but stopped because it was causing anxiety. 

I requested and received five years of medical records documenting a BMI over 40 (though I don't believe this is a Cigna requirement).  I had an EKG, a Barium Swallow and blood tests. All of my tests were normal and I have no co-morbid conditions, but my current BMI is 54.

I sent all my medical records to Duke on August 11th.  I was submitted to insurance on September 17th.  UHC gave me a problem and would not give me a letter in writing stating that WLS was an exclusion on their policy.  (They also told me they did not have a fax machine).  They said the only thing in writing they would give me would be a denial EOB after I had the surgery and submitted it to insurance.  They have still refused to send something in writing, but we submitted to Cigna with a copy of the plan documents.

It was submitted to Cigna on 9/22.  They initially decided to deny it on 9/25 stating that I did not have a nutritional eval.  Duke forgot to send it with the intial eval, I called Debra and she faxed it right over.  I called Cigna again and they said to expect a decision next week.  Debra from Duke called me at 4:15 on 9/25 (today) and told me that Cigna had called and approved it.  I called CIgna to confirm because it seemed too good to be true.

I had heard horrible things on here about Cigna and was really worried about insurance approval, I must say the process was very easy and everyone I talked to at Cigna was very helpful.  I have heard things about Duke being very slow and it did take a while to get my first appointment.   However, from the time they got my medical records until the time I was submitted to insurance was only a little over a month.  Everyone I have talked to over there has been very polite and helpful.  My approval from Cigna may have come faster because I called a lot.  I was always polite with them though. 

Anyway, that's my story.  I hope it helps someone who is reading all the bad stuff on here about Cigna.

I see a lot of people post with questions about the psychological evaluation.  This is what I experienced when I had my appointment at Duke.

I think my process might have been a little different, my appointment was scheduled only nine days after my brother died and I was an emotional basket case.  I basically told her that I was having panic attacks, not sleeping and taking xanax to get through the day and on top of that I was anxious about getting addicted to xanax because I was taking it daily.  She assured me that .25mg of xanax two times a day, nine days after a death in the family does not make an addiction, and while I knew that on an intellectual level, it made me feel better to hear it. 

My psych tests were normal though I did score high on the anxiety and depression scales.  I have struggled with anxiety my whole life and she made sure that I had skills to deal with anxiety and that the depression was situational and not out of proportion with the loss.

During the session (which lasted about 2 hours) she asked me questions to see if I was prepared for surgery.  She wanted to know if I had told anyone that I was having it.  What changes I anctipated would happen after surgery.  What my goals were?  What made me decide to have surgery?  etc.  I think she wanted to make sure that this was a well thought out decision and not one that I took lightly.

She said she didn't have any concerns about clearing me for surgery as long as I felt I was doing better over the next few months.

So that is my novel, but if I can make it through in that state, I think most people can.

UPDATE:  She was right about it being transitional anxiety.  My psych eval was on May 21st and the last time I took Xanax was in early July.