CIGNA INSURANCE APPROV

[Jnpxo2 35]

Hi everyone !!!

I recently decided to try the gastric sleeve option which my doctor supported. I am currently 223 pounds 5’2 so my bmi qualifies. Family history of diabetes and hypertension and heart disease cholesterol you name it they got it. The question I have is about the necessary documentation as far as documentation of weight loss within the previous 12 months. I had been going to Urban Skin solutions weight loss mes spa. Trying Lipo injections and phertamine to no avail I have the documents which show my bmi and weight for every visit. Would this be enough ?

[GreenTealael 25,323]

48 minutes ago, Jnpxo2 said:

Hi everyone !!!

I recently decided to try the gastric sleeve option which my doctor supported. I am currently 223 pounds 5’2 so my bmi qualifies. Family history of diabetes and hypertension and heart disease cholesterol you name it they got it. The question I have is about the necessary documentation as far as documentation of weight loss within the previous 12 months. I had been going to Urban Skin solutions weight loss mes spa. Trying Lipo injections and phertamine to no avail I have the documents which show my bmi and weight for every visit. Would this be enough ?

Every insurance company is different but it’s usually a medically supervised weight loss program (someone correct me if I’m wrong please).

To know for sure you need to ask the insurance company directly. Also there may or may not be a separate requirement from the Bariactric practice so check that as well.

If the owner of the spa is a licensed medical professional or there was a nutritionist on staff that may work. Even so you can ask your referring doctor to add your previous weightloss attempts with the spa to your records as a back up.

Here is Cigna’s info on Bariatric surgery (it’s long but page 2 describes what you are looking for)

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

Edited February 12, 2023 by GreenTealael

[Jnpxo2 35]

7 minutes ago, GreenTealael said:

Every insurance company is different but it’s usually a medically supervised weight loss program (someone correct me if I’m wrong please).

To know for sure you need to ask the insurance company directly. Also there may or may not be a separate requirement from the Bariactric practice so check that as well.

If the owner of the spa is a licensed medical professional or there was a nutritionist on staff that may work. Even so you can ask your referring doctor to add your previous weightloss attempts with the spa to your records as a back up.

Here is Cigna’s info on Bariatric surgery (it’s long but page 2 describes what you are looking for)

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

Thank you so much ! They are a medical provider I have the licensed signatures and diet plan the nutritionist suggested. Etc. hope it works. when they within the previous 12 months does that mean I had to have done it the entire 12 months or just within that time frame

[GreenTealael 25,323]

13 minutes ago, Jnpxo2 said:

Thank you so much ! They are a medical provider I have the licensed signatures and diet plan the nutritionist suggested. Etc. hope it works. when they within the previous 12 months does that mean I had to have done it the entire 12 months or just within that time frame

I think it just means all of the evaluations need to be current (within the past 12 months) but don’t quote me. 🤣

[SHONORS1324 8]

Hello,

Any updates? I have the same insurance CIGNA OAP..

[Jnpxo2 35]

I have oap as well through my job. My jobs policy excludes bariatic.

[SHONORS1324 8]

Did you get your surgery