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Cigna (Recent Apporval)



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Posted (edited)

I had my surgical consultation today for revision, but on the off chance that it is not deemed medically necessary for revision, I do qualify for bariatric surgery in general, repeating all of the requirements as if it were a new procedure. My question is regarding Cigna coverage. Most plans require a monitored 3, 6 or 12 month diet/nutrition/weight loss management through PCP or somewhere similar. Cigna's policy says NOTHING about this, only that "a statement from a physician other than the surgeon, that the individual has failed previous attempts to achieve and maintain weight loss by medical management" - it gives no other requirements or indicators. I called Cigna today to inquire and they couldn't tell me anything more about this.

So, for those of you that have been approved in the past few months (Cigna's policy requirements look to be effective 10/9/18 through 7/15/19), what did you provide for this? I have to have a letter from my primary anyway that recommends bariatric surgery. Would this be the same letter or separate? And what did you submit/have your PCP write to say that you had failed previous attempts? Thanks in advance for your help!

cigna.jpg

Edited by Add512

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I just had my surgery on the 21st, and I went through Cigna.

My doctor handled all of the preliminaries, I'll admit, but I was going through the bariatric surgeon to begin with, and he knew what they needed. I will say this, Cigna only required a 3-month medically assisted weight loss (I went through my endocrinologist) in which I could show that I was losing weight, if only a pound, between visits. It was tough. My doctor also had me go though a lot more, which I don't know if they were requirements for the insurance or his MO. I had to undergo a sleep study, a psych evaluation, an endoscopy, a visit with a nutritionist, a whole round of bloodwork and pap smear, mammogram, and clearance from a cardiologist.

Not sure if this helps or not, but I'm sure that if you call some bariatric surgeons in your area, they'll be able to check for you. I know mine has a couple of women dedicated just to insurance verification/communication. My advice is to let someone who knows what the insurance companies typically ask for and who has experience in dealing with them do the legwork if you can. If there is no one nearby, maybe go to someone in a bigger city nearby. (I was fortunate enough to already live in a big city, so I didn't have to do much digging.)

I hope all of this helps. Let me know if you need anything else from me.

I wish you the best! ❤️

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