Confused about what Cigna requires.

[TRN87 0]

I am a bit confused about what Cigna requires to cover the surgery. I spoke with a woman from my insurance company about a month ago and she told me that all Cigna required was that you have a BMI of 40 or more for at least a year. However, I heard that they also require 6 months diet with a nutritionist from someone recently. Can anyone help me out and let me know what all Cigna requires? I am a little bummed because I was hoping I could have my surgery by the end of the summer but if I have to do the diet it will be at least next October or later. I am just being impatient I guess?

Thanks.

Roxy:sad_smile:

[Wheetsin 714]

Insurance companies have different plans, and different plans are likely to require different things. E.g. I have a UHC plan, but had drastically different requirements than others here who have different UHC plans.

Why not just call Cigna and ask them what they require? They will be able to tell you exactly what's required for your individual plan.

[laurenwhite82 0]

I have Cigna and they do require 6 months medically supervised weight loss, plus I believe medical records proving your weight for at least a year. I am currently completing my 6 months and am hoping to be banded sometime late aug/early sept. Fingers crossed!

[cathychatts 1]

Roxy,

I have Cigna and I am working on the requirement for surgery. I spoke with the insurance company rep and here is what they told me, I have copied and pasted directly from the Cigna website. I am hoping that I have met the requirements, but not certain. I may have to begin the 6 months again, I figure if I will I will just work on it, they say the 6 months is to show that you have the desire to live the life-style required after banding, they say that the band is only a tool that will help you complete your weight loss and keep it off, that the real work is what you do. The band is not a "magic bullet" I think they are right on with that, after reading most all the post on here, I think the successful ones are the ones that really work hard at the lifestyle changes. I hope you are successful and I also hope that for myself. Keep in touch and let me know how things go! Seems we have a lot in common!

Cathychatts! (BE SURE TO READ THE FOLLOWING)

The Following came directly from the Cigna Website:

CIGNA HealthCare 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 one of the following:

BMI (Body Mass Index) ≥ 40 for at least the previous 12 months.

BMI (Body Mass Index) 35–39.9 for at least the previous 12 months with at least one

clinically significant comorbidity, such as a serious cardiopulmonary problem, Type 2

diabetes, hypertension, coronary artery disease, or pulmonary hypertension that has failed to

respond adequately to appropriate medical management.

• Active participation within the last two years in one physician-directed weight-management

program for a minimum of six months without significant gaps. The weight-management program

must include monthly documentation of ALL of the following components:

Page 2 of 28

Coverage Position Number: 0051

Vital signs, including weight

Current dietary program

Physical activity (i.e., exercise program)

Behavioral interventions to reinforce healthy eating and exercise habits

Consideration of pharmacotherapy with U.S. food and Drug Administration (FDA)-

approved weight-loss drugs, if appropriate

For individuals with lifelong, morbid obesity, participation in a program within the last five years is

sufficient if documentation of six months is available and reasonable compliance with the weightmanagement

program over an extended period of time can be demonstrated. However, diet

programs/plans alone, such as Weight Watchers®, Jenny Craig® and similar plans, are not

considered physician-directed weight-management programs and do not meet this requirement. Similarly, physician-directed programs consisting exclusively of pharmacological management

are not sufficient to meet this requirement.

• Recent evaluation by a multidisciplinary team including:

A thorough medical history and physical examination.

An evaluation by a licensed mental health care professional that specifically addresses

any mental health or substance abuse diagnoses, the emotional readiness and ability of

the patient to make and sustain lifestyle changes, and the adequacy of their support

system. If an individual is already in behavioral health treatment, consultation with their

treating clinicians should also be sought.

A thorough nutritional evaluation by a physician or registered dietician experienced in the

issues of bariatric surgery, who has had a meaningful conversation with the individual

regarding the dietary and lifestyle changes required to ensure a successful outcome over

time.

http://www.cigna.com/customer_care/healthcare_professional/coverage_positions/medical/mm_0051_coveragepositioncriteria_bariatric_surgery.pdf

[LSF 264]

I feel your pain! I have Tufts and they also require the 6 month weight loss program. I began this journey in late December and now, by the time all this is over, it could be as late as October/November.

[Carrie_C 9]

I have Cigna as well. All of my paperwork was submitted yesterday and I am waiting on a response. The insurance cooridinator told me that Cigna wants you to have completed the 6 month diet within the last year. She also said that they expect to see a 10% weightloss with the diet. You also have to have a nutrition and psych eval before submitting to Cigna. They also are more likely to approve it if you have 1 or 2 comorbidities. You also have to have a letter of medical necessity from your PCP. They are pretty strick. But all plans are different, so you might want to give them a call. If you have to do the 6 month diet, I would go ahead and do it. 6 months goes by faster than you think!!

[cakegal 0]

I atarted with Great-West Healthcaare three months ago, and they were bought out by cigna in February. I know have an open access plan. I'm told that's a good one. I sure hope so. I've submitted a copy of my new insurance card to my coordinator and am waiting for instructions. I'm currently doing the six month supervised program, and am assuming that will count with Cigna as well. Anyone have open access?

[Carrie_C 9]

I also have Open Access. I am hoping they are good. I looked at my benefits on their web site and it says my coinsurance for bariatric surgery is 15%. So maybe they will cover it since it says that (hopefully). The 6 month program you are doing should count. I don't think it matters if you had Cigna when you started. I just got Cigna in January, and I did the 6 month diet last year when I had Aetna. The insurance cooridinator said it shouldn't matter, they don't ask for records. So that is good.