CIGNA requirements HELP

[Heather120617 0]

I need a little help from others that have been approved with CIGNA. THIS Is the most up to date policy (see below). They actually update their policy on the 15th of July so it was revised and updated today. No changes were really made. Anyways, I do meet the requirements but my question is regarding Cigna coverage. Most plans require a monitored 3, 6 or 12 month diet/nutrition/weight loss management through PCP or somewhere similar. Cigna's policy says NOTHING about this, only that "a statement from a physician other than the surgeon, that the individual has failed previous attempts to achieve and maintain weight loss by medical management" - it gives no other requirements or indicators. I called Cigna and two different reps confirmed that it is not required. Although when I went to my Drs appointment they told me they thought it was six months worth of supervised diet! I think they are confused bc of the “within the last six months” part. SIGH! They said they will look into it more

So, for those of you that have been approved in the past few months, do I have to have a letter from my primary that recommends bariatric surgery? Would this be the same letter or separate from the on where they state I have made several attempts and failed? And what did you submit/have your PCP write to say that you had failed previous attempts? Thanks in advance for your help!

Sorry I just know Insurance’s are so picky!

below is link to coverage

https://static.cigna.com/assets/chcp/pdf/coveragePolicies/medical/mm_0051_coveragepositioncriteria_bariatric_surgery.pdf

[catwoman7 11,221]

hmmm....doesn't sound like it. Hopefully someone from your clinic will contact them to see for sure. The insurance people at bariatric clinics are pretty good at this - after all, they don't want to lose a patient, especially after sending them through all the other clearances!

[CapeFearNC 6]

I have Cigna through my employer and it all depends on how the policy is written regarding Bariatric surgery. My policy shows one thing when you look it up online but when anything is submitted it gives not covered by policy. Putting my medical billing & coding to work i did little digging and found that it actually was in the underwriting of the policy that it excludes weight loss surgery. Yes i have been under my PCP care for health issues related to my weight along with weight management (meds/diet/etc) my surgery is also a medical necessity as i have OSA, NAFLD, & PCOS. Even after both my PCP & OBGYN gave the "medical necessity" insurance still will not cover any form of bypass surgery and has left me to figure it out on my own.
After lots of medical practice locations/surgeon research, i decided to proceed with having a Vertical Sleeve which will be done by one of the surgeons at Blossom Bariatrics (fast track program). They will utilize my insurance for all the Pretesting labs, stress test, upper Endoscopy but i have to cover the surgery procedure part out of pocket. Between my husband and i we were able to obtain a medical loan to assist in the remaining amount we needed and my surgery date was scheduled for week of Sept 7th so my countdown is on!!!!!

[Corrine2020 12]

Hi There!

I had this EXACT same question regarding the Cigna insurance monthly diet requirements back in June. I even posted about it and received answers all over the board. I know that all policies can vary but I was running into the same situation you are where I was reading it online and even took the step to call Cigna twice and couldn't get a straight answer out of them - it was odd like they had no clue and they also kept reading what the online policy stated. Which omits any type of monthly dietary requirements.

However, when I went to my bariatric surgeon for my first visit they immediately stated that my Cigna insurance no longer required the 3, 6 or 12 month diet program as they had done in the past.
I completed all the necessary steps (endoscopy, cardio stress, psych eval) and my surgeons office submitted it to Cigna for approval today. So, now we wait and see....

[blackgirlmagicrnybypass 0]

Just to jump in on this, I have Cigna through my employer. I ran into the same issue where my PCP wouldn’t document my failed attempts with weight loss so now I have to complete 4 months of monthly weight loss management with my surgeon

[Circlesis 59]

Years ago I was required to do 3 monthly visits on Cigna, however same policy this year for 2nd surgery there was no such requirement.

This time it was only one visit with the nutritionist, one psych clearance, one letter from pcp stating he recommends bari surgery for me.

Second point - my surgeons office initially told me my plan didn’t cover Bariatrics at all. I called Cigna myself and in fact it was covered at 100%. 🤷‍♀️

[Horseshowmom 45]

I was approved by Cigna this month. I met the doctor for my initial consult in mid August and the patient insurance/billing advocate was like, how fast do you want to get this done. I didn’t want surgery until November because of things we already had on our schedule, but I could have had surgery already. I had 1 psych eval, 1 visit with a dietitian, h pylori test required by doctor, and an online meeting/class about weight loss surgery. That’s it, my pre-op appointment is next week and my surgery is the following. I didn’t have to jump through any hoops and my surgery was approved in 2 days after the weight loss clinic submitted my paperwork for approval.

[maslman 65]

I was approved in September through Cigna. I needed a letter of medical necessity from my PCP, which was sent to the surgeon and his office submitted everything. My PCP didn't give me any trouble at all and sent the letter within a week of me seeing him to request it. He did make me come in for an appointment to do that. Other than that it was the standard meet with a Psychiatrist, meet with a nutritionist, upper endoscopy, a 1 month weigh in, and finally clearance for surgery from my PCP and any other hoops that were required by the hospital/surgeon (covid test, EKG, blood work, etc.).