CIGNA Coverage Policy - Effective 10/9/2018

Walter Lindstrom · November 2, 2018

This may have been discussed before but for anyone covered by CIGNA or one of its affiliated companies, they have abandoned their prior formal requirement of a specific duration (e.g. 3 months) in favor of this language:

• A statement from a physician/physician’s assistant/nurse practitioner/registered dietician (i.e., other than the requesting surgeon) that the individual has failed previous attempts to achieve and maintain weight loss by medical management.

This is the old language:

• Medical management including evidence of active participation within the last 12 months in a weight-management program that is supervised either by a physician/physician’s assistant/nurse practitioner or a registered dietician for a minimum of three consecutive months ((i.e., ≥ 89 days). The weight-management program must include monthly documentation of ALL of the following components:

 weight

 current dietary program

 physical activity (e.g., exercise program)

Programs such as Weight Watchers®, Jenny Craig® and Optifast® are acceptable alternatives if done in conjunction with the supervision of a physician/physician’s assistant/nurse practitioner or registered dietician and detailed documentation of participation is available for review. However, physician-supervised programs consisting exclusively of pharmacological management are not sufficient to meet this requirement.

Anyone covered by CIGNA now and going through a mandatory weight loss program under the old medical policy should request their surgeon/bariatric program to submit their request for approval NOW and not wait to finish the supervised diet. You might get some push-back from crusty bariatric practices or surgeons, but hopefully they will help you. The new policy is more favorable to patients, and because it is the medical policy in effect for anyone having surgery after October 9th, we take the position this is the operative medical policy - NOT the policy at a patient's "starting point".

Call us at 1-877-992-7732 if you have questions about this or are in need of any information about what you need to do if you have been denied by your insurer - whether it is CIGNA or any other payer. Good luck to all!

CIGNA medical policy effective October 9 2018.pdf