I researched and verified all the requirements for my Cigna insurance before getting started. I started my process on May 29, 2018. This was my first of the 90 days worth of appointments for medically supervised diet. I attended seminar on June 10, and saw surgeon for initial on June 26. I attended my nutrition class, for my psych eval. Then on July 15,2018, Cigna put out a NEW policy on Bariatric surgery coverage and requirements. Really?? Who does that in the middle of the year?? Anyway.. the new policy does not require the 90 days anymore. It requires a letter stating you have failed medical weight loss in the past and that it is medically necessary and that you are cleared for surgery. No mention of records to back that letter up. So, I called CIGNA to find out how long the letter needs to state that has been a problem, and if records are needed to go along with it. All they can tell me is that records are not listed as a requirement. In a way this put me ahead of the game, because my last weight-loss appointment isn’t scheduled until the last day of August. My paperwork was submitted to Cigna yesterday. Has anyone had to deal with this since July of this year with the changes to the Cigna policy?

Wow, I had Cigna and had to do the 3 month diet. They were great though, they approved my VSG in less than 24 hours, even with a lower BMI and osteoarthritis as my comorbidity.

On June 8, 2018, EmblemHealth GHI also changed their criteria by "remov[ing] pre-surgical dieting prerequesite and statement that member must not have a life threatening condition". Of course, my surgical center didn't know this until I brought it to their attention yesterday (just as I am completing my six months of pre-surgical dieting and monitoring (I started the process in March). Of course, this is annoying for those of us that were stuck in the middle, but it's a good thing overall--since you're not going to rejected from coverage because of any weight gain or lose (or insufficient loss) etc. These changes are consistent with American Associate of Metabolic and Bariatric Surgery recommencations and position paper from 2016 and all the latest studies which show that these approval requirements are not supported by any medical evidence. To the contrary, the evidence shows these requirements are harmful. I expect more insurance carriers have changed their policies are will soon be changing their policies to fall in line.

ANy update?

I got my approval today! I called around noon and was told they had it and it was under Nurse review and I should have a decision by Friday. About 2 hours later I went on the portal to look up something about the mail order pharmacy and it had updated to APPROVED! They took less than 4 full business days. I am thankful and amazed!

This is GREAT to hear! I just got my Cigna back and I was going to call the surgeon on Tuesday to start the process. It’s good to know that, all I need is a letter from my pcp. Congratulations on your approval.