cigna insurance?!?!

[desteneys 4]

Do they pay for wls? If so whats the qualifications?!

[Jen35 283]

I have Cigna and I was given a document outlining the general guidelines. I've copied/pasted some of the information. You will want to call to verify what is covered by your individual plan.

Coverage Policy

Bariatric surgery is specifically excluded under many benefit plans and may be governed by state and/or federal mandates. Please refer to the applicable benefit plan document to determine benefit availability and the terms and conditions of coverage.

Unless excluded from the benefit plan, this service is covered when the following medical necessity criteria are met.

Cigna covers bariatric surgery using a covered procedure outlined below as medically necessary when ALL of the following criteria are met:

• The individual is ≥ 18 years of age or has reached full expected skeletal growth AND has evidence of EITHER of the following:

 a BMI (Body Mass Index) ≥40

 a BMI (Body Mass Index) 35–39.9 with at least one clinically significant obesity-related comorbidity, including but not limited to the following:

o mechanical arthropathy in a weight-bearing joint

o type 2 diabetes mellitus

o poorly controlled hypertension (systolic blood pressure at least 140 mm Hg or diastolic blood pressure 90 mm Hg or greater, despite optimal medical management)

o hyperlipidemia

o coronary artery disease

o lower extremity lymphatic or venous obstruction

o obstructive sleep apnea

o pulmonary hypertension

•Medical management including evidence of active participation within the last 12 months in a weight-management program that is supervised either by a physician or a registered dietician for a minimum of three consecutive months. The weight-management program must include monthly documentation of ALL of the following components:

 weight

 current dietary program

 physical activity (e.g., exercise program)

Programs such as Weight Watchers®, Jenny Craig® and Optifast® are acceptable alternatives if done in conjunction with the supervision of a physician or registered dietician and detailed documentation of participation is available for review. However, physician-supervised programs consisting exclusively of pharmacological management are not sufficient to meet this requirement.

•A thorough multidisciplinary evaluation within the previous six months which includes ALL of the following:

 an evaluation by a bariatric surgeon recommending surgical treatment, including a description of the proposed procedure(s) and all of the associated current CPT codes

 a separate medical evaluation from a physician other than the requesting surgeon that includes both a recommendation for bariatric surgery as well as a medical clearance for surgery

 unequivocal clearance for bariatric surgery by a mental health provider

 a nutritional evaluation by a physician or registered dietician

Bariatric Surgery Procedures:

When the specific medical necessity criteria noted above for bariatric surgery have been met, Cigna covers ANY of the following open or laparoscopic bariatric surgery procedures:

•Roux-en-Y gastric bypass

•adjustable silicone gastric banding (e.g., LAP-BAND®, REALIZE™)

•biliopancreatic diversion with duodenal switch (BPD/DS) for individuals with a BMI (Body Mass Index) > 50

•sleeve gastrectomy (SG)

•vertical banded gastroplasty

[ArcusX 216]

NIce post, Jen. I coudn't find anything at mycigna.com.

I called Cigna just a day or two before my first consult and was told that my policy did not cover, but when I went for my consult, I was told that it does. I'm going with the doctor's office, because they're not going to do it if they won't get paid. I just finished all my pre-op stuff, and was told they are submitting for approval today.

[banditchic 83]

I was submitted to Cigna last Tuesday. I am so impatient! I called Cigna today, and they told me it was still in the review process. I just have this sick feeling that they will find some reason to deny me....uggghhh.

[Jen35 283]

Jussme - I know the feeling! The office should have submitted everything to Cigna on Friday (12/7) and it's just a waiting game now. I'm worried they won't approve.

ArcusX - They don't make the information easy to find. If you want the full pdf document, message me your email. Originally, my surgeons office called Cigna to verify coverage and were told no. I called Cigna too and was told it was. The office called back and got a yes. Apparently, the rep was quoting the coverage for non-surgical weight loss. You sooo have to be your own advocate and keep looking until you find the answer.

[desteneys 4]

Finges crossed(: