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Cigna- Requirements and Timeline



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Posted (edited)

Hi!

I'm looking at getting DS. I am currently in the process of finding a surgeon/WLS program.

I am trying to find out if anyone here has gone thru the process of getting Cigna to cover their surgery since the beginning of 2019 (from what I can tell there was a policy change but I'm not sure what that change entails). What kind of waiting period did you have to go thru? Other requirements?

I'm *hoping* to be able to get my surgery done by the end of July- my Cigna insurance runs out then due to me turning 26.

Any input/insight would be appreciated.

Thank you!

Edited by PeaceDove24

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I'd contact Cigna directly and ask about their requirements. It is almost June, and many insurers have a 3-6 month waiting period where you need to be having monthly dietitian and nutrition visits. I imagine You'll need a psych evaluation, cardiac clearance, etc. Getting it done by the end of July will be tough, I think. But good luck. I initially wanted DS, but my surgeon and his group do not perform it.

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1 hour ago, Briswife15 said:

I'd contact Cigna directly and ask about their requirements. It is almost June, and many insurers have a 3-6 month waiting period where you need to be having monthly dietitian and nutrition visits. I imagine You'll need a psych evaluation, cardiac clearance, etc. Getting it done by the end of July will be tough, I think. But good luck. I initially wanted DS, but my surgeon and his group do not perform it.

Sent from my SM-N960U using BariatricPal mobile app

I called Cigna this past Friday (5/17) morning to ask, the lady I talked to was very confused when I asked if there was a required waiting period and on the sheet she sent me (below hopefully) it doesn't say anything about a required waiting period- just that I have to have a Doc sign off that I haven't had success losing weight in the past and have done a Nutrition eval, psych eval, and gotten clearance from my PCP in the past 6 months.

Thankfully I'm not attached to a single surgeon- I can go to any surgeon I want that is In-Network and thinks I'm qualified (and has the availability to do it within my time frame).

Bariatric Surgery.pdf

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I read through that...it sounds encouraging! No monthly nutritionist visits, which is usually what slows people down. Hoping you get it done in your time frame! Best to you!!

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15 hours ago, PeaceDove24 said:

Hi!

I'm looking at getting DS. I am currently in the process of finding a surgeon/WLS program.

I am trying to find out if anyone here has gone thru the process of getting Cigna to cover their surgery since the beginning of 2019 (from what I can tell there was a policy change but I'm not sure what that change entails). What kind of waiting period did you have to go thru? Other requirements?

I'm *hoping* to be able to get my surgery done by the end of July- my Cigna insurance runs out then due to me turning 26.

Any input/insight would be appreciated.

Thank you!

Hey there! I just got approved by Cigna this week! Their requirements are: a recommendation from a nutritionist, a psych recommendation, a recommendation from the surgeon, and a recommendation from a physician who is not the surgeon nor is affiliated with the surgeon (my PCP provided this). Cigna does not have specific requirements for a medically-supervised diet, and I did not do one. That said, I have heard of PCPs/surgeons not giving you a recommendation until you meet a requirement that they have, but Cigna does not have a physician-supervised diet requirement as of right now. As soon as my surgeon’s office received those 4 things, it was sent off and my surgery was approved within 4 days. The whole process took a few weeks but only because of my schedule and having to move appointments around. I hope that helps!! Good luck!

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13 minutes ago, LessFee said:

Hey there! I just got approved by Cigna this week! Their requirements are: a recommendation from a nutritionist, a psych recommendation, a recommendation from the surgeon, and a recommendation from a physician who is not the surgeon nor is affiliated with the surgeon (my PCP provided this). Cigna does not have specific requirements for a medically-supervised diet, and I did not do one. That said, I have heard of PCPs/surgeons not giving you a recommendation until you meet a requirement that they have, but Cigna does not have a physician-supervised diet requirement as of right now. As soon as my surgeon’s office received those 4 things, it was sent off and my surgery was approved within 4 days. The whole process took a few weeks but only because of my schedule and having to move appointments around. I hope that helps!! Good luck!

This is AWESOME to hear. Hopefully the PCP I meet with tomorrow (new PCP I'm "interviewing" to find a new one) can give me that physician-recommendation. But I wonder, if it could come from my Endocrinologist. I know she said she couldn't do a referral for insurance, but if it's just a recommendation letter....

Now I just have to find a surgeon that is in network and doesn't require a supervised diet/classes.

Can I ask what surgeon you're using?

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17 minutes ago, othella2 said:

Did they say you has to do the 6 Month weight loss before??

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I've never asked about it directly to them before. I am pretty sure I looked up requirement several years ago and there was a 6 month stipulation. But there is not one now.

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I've never asked about it directly to them before. I am pretty sure I looked up requirement several years ago and there was a 6 month stipulation. But there is not one now.
You should call the insurance directly. I called mine often to make sure I had everything right. It's easier to get through to the insurance if you call in the morning.

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10 minutes ago, othella2 said:

You should call the insurance directly. I called mine often to make sure I had everything right. It's easier to get through to the insurance if you call in the morning.

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I called them this past Friday at ~8am. Got thru relatively easily. The issue is that they couldn't find any actual requirements related to a waiting period.

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2 hours ago, PeaceDove24 said:

This is AWESOME to hear. Hopefully the PCP I meet with tomorrow (new PCP I'm "interviewing" to find a new one) can give me that physician-recommendation. But I wonder, if it could come from my Endocrinologist. I know she said she couldn't do a referral for insurance, but if it's just a recommendation letter....

Now I just have to find a surgeon that is in network and doesn't require a supervised diet/classes.

Can I ask what surgeon you're using?

I’m in Dallas, and I’m using Dr. Jeffrey Henke. His office is great. Before your appointment with him, they send you a copy of the requirements for surgery that are specific to your insurance. I had the psych appointment booked before I even saw him.

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2 hours ago, othella2 said:

Did they say you has to do the 6 Month weight loss before??

Sent from my Moto E (4) using BariatricPal mobile app

Nope. Cigna only has those 4 requirements that I mentioned above. There is no 6-month requirement or medically-supervised diet requirement of any kind at this time. The current requirements are good through July, so it may change after that. But for now, I was approved submitting the 4 items I listed above per Cigna’s current policy.

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On 5/19/2019 at 6:46 PM, LessFee said:

Nope. Cigna only has those 4 requirements that I mentioned above. There is no 6-month requirement or medically-supervised diet requirement of any kind at this time. The current requirements are good through July, so it may change after that. But for now, I was approved submitting the 4 items I listed above per Cigna’s current policy.

This is so crazy. I'm trying to get the DS, so can't go with Henke since he doesn't do that- but I just talked to another Dallas/Fort Worth surgical center that told me (before verifying insurance) that Cigna has a 1 month diet requirement.

I'm just like. Y'all. Get your stories straight?

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I have Cigna and I was under the impression that the DS surgery is not covered by Cigna at this time (or wasn’t last year when I had the sleeve).


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