Cigna has revised their coverage terms for bariatric surgery as of 5/15/08. They now require 24 months proof of obesity. Also looks like they now accept Weight Watcher if done under supervision of a doctor.

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, physiciansupervised

programs consisting exclusively of pharmacological management are not sufficient to

meet this requirement.

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

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

treatment

a separate medical evaluation recommending bariatric surgery

clearance for surgery by a mental health provider

a nutritional evaluation by a physician or registered dietician

Bariatric Surgery Procedures:

When the specific medical necessity criteria noted above for bariatric surgery have been met,

CIGNA HealthCare covers ANY of the following bariatric surgery procedures:

• vertical banded gastroplasty

• Roux-en-Y gastric bypass

• adjustable silicone gastric banding (e.g., LAP-BAND®, REALIZE™

)

• biliopancreatic diversion with duodenal switch (BPD/DS) for individuals with a BMI (Body Mass

Index) > 50

CIGNA HealthCare covers adjustment of a silicone gastric banding as medically necessary to

control the rate of weight loss and/or treat symptoms secondary to gastric restriction following a

medically necessary adjustable silicone gastric banding procedure.

Thanks for the info!

This worries me. I am almost done with all their requirments but I do not have the 24 month weight proof. I have one Dr's record from 2-07 and that is it. I don't see a doctor very often so the only other record I could come up with would be from when My daughter was born in 05 but I did not have a 40 bmi then maybe a 36 or so and I do not have any other weight related issues. When it was just the 12 month I was find but now I am worried I will not get approved.

thanks so much for posting this! i have cigna and thought i had everything covered. jeez i hate insurance. so i haven't really told my pcp about the lap band thing and now i guess i have to face the music. do i just ask her for a letter about my weight over the past 2 years? do i have my hospital call her? i'm so confused...

Trish,

I wouldn't be afraid of you PCP, they work for you. Is you hospital submitting the paperwork for insurance approval? Why don't you ask them? So far the only thing that I've had to get from my PCP was a letter stating I was OK physically to have the surgery. You may need to have a physical for them to write this letter, and I believe it's required for approval. You probably should've started this process a month or so ago...

Oscar

Hey. I'm all done with every other Cigna requirement which is why this is annoying now. My hospital is sending in my paperwork for approval so I'll talk to them next week when I go in for my last group meeting thing. I just know my pcp is gonna charge me for the letter if that's what I need and that's annoying. Thanks for replying!

this all seems so arbitrary. I have a tentative surgery date--July 1--but my paperwork has not been submitted yet. The surgeon's office suggested I get additional paperwork documenting the 6 month diet. The few additional days may mean the difference between approval and denial. Trying to stay positive.

Noooo. Say it isn't so. I just did my 5th official weigh in last week. I have the requirements for my insurance on a sheet given to me from the surgeon's office. It doesn't state anything about a 12 or 24 month weight history. Is this for ALL Cigna insurance? I am praying not. I finally got a PCP this past year since I rarely get sick. For the past 5 years, I usually went to the ER ( I was in college, no insurance, and the hospital offered billing based on income). So I hope they can trace my weight history if necessary:sad: What do you guys think?

Thanks for the post about CIGNA. I am in month 4 of the weight loss requirement and am not sure that my BMI has been 35 or higher for 24 months. I hate that they can just change the rules whenever they want. I guess I need to talk to my Primary Doc and the surgeon. Anyone else had any luck with this?

Thanks for posting this. I just finished the six months nutritionist and my PCP is just now writing the letter. I was worried because we can only find 4 years of me going to them, now I feel a little better with the 24month revision. Hopefully the letter will be faxed to the surgeon tomorrow and I can move forward with this.

I was approved with only 2 years of medical history, which I'm glad because I too only had about 4 years worth. Also the only thing my PCP provided was a small statement on my physical that mentioned I was getting lapband surgery for obesity, no long letter needed. Make sure to call Cigna a couple of days after the paperwork is submitted and see if they have it. When I called they had received it but hadn't sent it to a nurse yet for approval. The guy I spoke with was very nice and he sent it on, 4 days later I was approved. Good luck.

Oscar

Edited August 18, 200817 yr by oscarel