Cigna Exclusion?!?

[chyna86 17]

Just found out my group insurance with my employer has an exclusion for bariatric surgery. The insurance specialist at the doctors office I chose called on my behalf and found out that surgery is covered if deemed medically necessary. She was advised by to send in my hight, weight, and BMI for a "Precertifiation". This seemed very scant but she was advised this was all the info that was needed. My BMI is 40 on the dot.

Has anyone else had experience with this "Precertification" process?? It will take 3 weeks to get an answer back. My nerves are wrecked!

[katrinas1974 0]

I have Cigna as well. I have my consultation on February 27. I will prepare myself to have to get pre certified.

[DELETE THIS ACCOUNT! 12,703]

Most insurance does require precertification. Some have weight/BMI requirements, some require 1-2 co-conditions directly effect by weight (i.e. diabetes, high blood pressure, etc.) Some even have a 6 month waiting period, during which you must attend a program like Weight Watchers.

I wouldn't worry about it. It's pretty normal.

[chyna86 17]

I have Cigna as well. I have my consultation on February 27. I will prepare myself to have to get pre certified.

Make sure your surgeons office has a dedicated insurance team! My first choice of surgeon called me back right after I made an appt. to tell me I would have to pay out of pocket because my insurance has an exclusion. Defeated, I cancelled my consult with my second choice of surgeon and they called me back to encourage me to still come in. They got Cigna to admit it would be covered if deemed medically necessary and are helping to push my insurance. Not too sure what my chances are but having the surgeons insurance team is definitely a help