Will Cigna cover me?

[GOTIGERS 2]

Hello Everyone,

I am 5'3 and 225 pounds. My BMI is forty. I want to feel better, I am so tired of failing at every attempt of dieting. I have 2 children that I want to live a long healthy life for.

I have been told by so many people that it is really hard to get Cigna to cover WLS. People also keep telling me that I am not "big enough" for WLS. It's so disheartening to be told that there is no way I am going to be able to get Cigna to cover my surgery. I am so new to this, and really looking forward to getting any advice I can get about how to go about getting everything covered.

Thank you

[poginut 112]

Hi, My BMI is 37.5 was approved by my insurance. I think if your BMI is 40, it should be easier for you as you don't have the requirement of co morbidity. I also think the definition below is standard with all insurance. My insurance is GEHA. Hope this helps and good luck.

"Morbid obesity is diagnosed by determining Body Mass Index (BMI). BMI is defined by the ratio of an individual’s height to his or her weight. Normal BMI ranges from 20-25. See BMI on back panel. An individual is considered morbidly obese if he or she is 100 pounds over his/her ideal body weight, has a BMI of 40 or more, or 35 or more and experiencing obesity-related health conditions, such as high blood pressure or diabetes."

[finediva 979]

Well have you called your insurance company or tried to look up their policy on line? Also if you attend a WL seminar there will be someone there who will be able to answer questions about different kinds of insurance. The surgeons who perform these surgeries have staff who are familiar with the different insurance companies, their policies and appeal process. I was 230 with bmi of 40. None of my friends considered me obese. To them I was thick. Well I knew better!!

[GOTIGERS 2]

I am signed up for a seminar this upcoming Saturday. I'm really looking forward to learning more about it.

[finediva 979]

I am signed up for a seminar this upcoming Saturday. I'm really looking forward to learning more about it.

Yes, it will be good for you to attend one. Some doctors and wl centers require it also. It will be a good time to hear all different options, what the surgery entails and ask your questions. Best of luck on your journey.

[GOTIGERS 2]

Thank you Have you had your surgery yet?

[finediva 979]

Thank you Have you had your surgery yet?

Yes, July 18th 2014.

[GOTIGERS 2]

Well congratulations! How are you feeling? Glad you did it? Sorry to be so nosy

[Jersrose43 837]

Cigna will cover weight loss as follows. And you are not to small at all

Over 40 bmi with no comorbidities

35-40 with comorbidities: high blood pressure, sleep apnea, diabetes etc

Lastly and most importantly. CALL CIGNA NOW

Many policies are through an employer and an employer can choose to exclude bariatric surgery. Their choice not yours and these exclusions are not something you can overcome.

Once you met each of those -

You have to see the nutritionist 3 times with greater than 89 days. Not 88 not 3 months. 89

You must get your pcp or other doctor - not surgeon - to write a letter that it's necesary for you

You will need a psych clearance

You may need an upper GI or ultrasound of abdomen but I've found that to be based on doctor requirements not cigna.

Good luck

I was approved at 39 bmi and hbp

The issue i had was making sure office sent all documents over to cigna. No problems otherwise

[finediva 979]

Well congratulations! How are you feeling? Glad you did it? Sorry to be so nosy

Not being nosey at all. I feel great. Only when I eat I remember I had 85% of my stomach removed. Right now I'm struggling with a two week stall and just want the scale to move!

[finediva 979]

Well congratulations! How are you feeling? Glad you did it? Sorry to be so nosy

Sorry, didn't answer all. Most days I'm glad I did it. The stall is discouraging right now, but I understand it's normal for most. When I'm eating 600 to 700 calories a day and walking 3 to 4 days a week and not losing, I get confused by the process. I start thinking I removed my stomach to lose 28 pounds. But it's done. I have to stay the course. Hope I've not been a negative nellie. Just telling my journey so far.

[K*L*L 26]

Cigna will cover weight loss as follows. And you are not to small at all

Over 40 bmi with no comorbidities

35-40 with comorbidities: high blood pressure, sleep apnea, diabetes etc

Lastly and most importantly. CALL CIGNA NOW

Many policies are through an employer and an employer can choose to exclude bariatric surgery. Their choice not yours and these exclusions are not something you can overcome.

Once you met each of those -

You have to see the nutritionist 3 times with greater than 89 days. Not 88 not 3 months. 89

You must get your pcp or other doctor - not surgeon - to write a letter that it's necesary for you

You will need a psych clearance

You may need an upper GI or ultrasound of abdomen but I've found that to be based on doctor requirements not cigna.

Good luck

I was approved at 39 bmi and hbp

The issue i had was making sure office sent all documents over to cigna. No problems otherwise

I have CIGNA, and those were exactly my requirements. I had my paperwork submitted at the end of last week, and I got the call today that CIGNA approved me to have the sleeve. You just need to call and make sure your particular plan does include bariatric surgery.

[friejenn 42]

So Cigna says my sleeve surgery is not medically necessary. I am 248 and 5'6". My BMI is 40. So the office is going to call and talk with them. I really need and want this surgery! Pray for me please

[GOTIGERS 2]

I totally feel your pain! Friejenn! I think your surgeon's office will know exactly what to say to them to get it approved. Don't give up! I keep having to tell myself the same thing, but I know if it's meant to happen, it will.

[Jersrose43 837]

Please read the medical policy and call Cigna to determine which pieces are unmet

If the office did not send all required documentation it willbe denied. Also call Cigna and determine if your employer has made separate rules for your plan. Below is the national policy

https://cignaforhcp.cigna.com/public/content/pdf/coveragePolicies/medical/mm_0051_coveragepositioncriteria_bariatric_surgery.pdf