ccarter8219

You may e-mail me at mike.carter8299@hotmail.com if you have other questions. Crystal

• Evaluation by a multidisciplinary team within the previous 12 months which includes the following:

1. an evaluation by a surgeon qualified to do bariatric surgery recommending surgical treatment

2. a separate medical evaluation recommending bariatric surgery

3. clearance for surgery by a mental health provider

4. a nutritional evaluation by a physician or registered dietician

hope this helps. Crystal

cont'd

Programs such as Weight Watchers?, Jenny Craig? and Optifast? are acceptable alternatives if done in conjunction with physician supervision and detailed documentation of participation is available for review. For individuals with long-standing, morbid obesity, participation in a program within the last five years is sufficient if reasonable attendance in the weight-management program over an extended period of time of at least six months can be demonstrated. However, physician-supervised programs consisting exclusively of pharmacological management are not sufficient to meet this requirement.

Continued…see next post…Crystal

cont'd

1. Active participation within the last two years in one physician-supervised 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:

weight

current dietary program

physical activity (e.g., exercise program)

continued...see next post...crystal

cont'd

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 one of the following:

1-BMI (Body Mass Index) ≥ 40 for at least the previous 24 months.

2-BMI (Body Mass Index) 35–39.9 for at least the previous 24 months with at least one clinically significant comorbidity, including but not limited to, cardiovascular disease, Type 2 diabetes, hypertension, coronary artery disease, or pulmonary hypertension.

Continued...see next post...Crystal

Alisa, I am not sure what cigna's requirements are, but the standards are but I googled cigna and obesity requirements and this is what I found.

Effective Date............................9/15/2008

Coverage Policy

Bariatric surgery is specifically excluded under many CIGNA 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 e is covered when the following medical necessity criteria are met.

Continued...see next post...Crystal