Cigna

lilbit08 · August 29, 2008

Anyone have Cigna? If u do, what were u told as far as the coverage for WLS...How can I find out of the Cigna I have covers WLS? I will have insurance thru Cigna with my new company in 2 mnths. Please advise!:biggrin:

ladyB · August 29, 2008

Cigna paid for my lapband. What exactly do you need to know regarding WLS with Cigna? I have been through a great deal with them, so please feel free to ask away. I am not an expect, but it took me almost 6 months to get approved. I know with my Cigna policy I had to be in Center of Excellence. This was half of the battle as I was not aware of this. So if you are just starting out, clarify if you will need to be in center of excellence.

Hope this helps.

I live in Grand Prairie Texas.

Banded on July 21st .....started out at 207 and down to 180.

I had my surgery at UT Southwestern.

CMTurner · August 29, 2008

First find out if the plan your employer picked covers bariatric surgery. If they have an exclusion for weight loss surgery you are pretty much out of luck unless you can talk to the HR people and see if they are willing to make an exception for you or if they are willing to make those changes when they renew.

If it is covered under your specific plan, please see the following link which is Cigna's coverage position on bariatric surgery from their website.

http://www.cigna.com/customer_care/healthcare_professional/coverage_positions/medical/mm_0051_coveragepositioncriteria_bariatric_surgery.pdf

h@rt*s mommy · August 29, 2008

I have the Cigna OAP, IF thats what you have, its very easy with them, it will take you 6 months, because they require the 6 months under doctors care, but then after that, if you have a great surgeons office, that will line up the sleep study, the nutritionalist appointsments, and all that great stuff that you do BEFORE you see the surgeon, it shouldnt take that long.

Feel free to contact me personally, and I could give you my number, its very easy, really it is, I jumped through all the Cigna hoops for a lot of people at my Surgeons office. I personally got on the phone and called them many many times, because I was going to take control of what I have been dreaming about for years it seemed like. Now, my surgery in scheduled for next month, and I cant wait!

Hope this helps

lilbit08 · August 30, 2008

What is a Center of Excellence? I am not sure yet what exact policy it is. I just know that it is Cigna. I won't have insurance for another 2 mnths but I am just checking ahead of time. I am really intrested in getting VSG (Vertical Sleeve Gasterectomy), but didn't have good luck with getting financed for the amount needed. In the summary of benefits already given to me by my new employer, it states that "coverage will not be provided for the following unless medically necesssary"...and they mention cosmetic surgery but nothing that relates to WLS, so I am not sure what to think?:biggrin:

Edited August 30, 2008 by lilbit08

h@rt*s mommy · August 30, 2008

Cigna has many different plans, like HMO PPO type, or like mine its OAP. Certain cigna plans will NOT cover it, but most insurance plans will ocver your surgery if its medically necessary. Mine says the same thing about WLS, but it DOES state that gastric surgeries are permitted as long as it is medically necessary. So thats something to think about.

Good Luck

Elaine

CMTurner · August 31, 2008

lilbit

If you look at the link I posted above it shows Cigna's coverage position as it pertains to weight loss (bariatric) surgery. Remember this only applies if the company you are employed by opted to cover weight loss surgery. It does NOT cover the gastric sleeve procedure. Only lapband and gastric bypass at this time. Hope this helps.

ShellShock · September 3, 2008

If you already have your member number you should call the insurance company and see what they say about your specific plan.

The link that was provided above for cigna is exactly what you need to know if you are covered. You will need do the six month physician supervised diet, do a psych visit and see a nutritionist. It was simpler than I though it would be. Once my paperwork was submitted it only took 11 days for approval.

lilbit08 · September 6, 2008

wow..thanks for the info! ur's went well. i dont have any of the insurance info as of yet except that it is cigna and that is all i know...i will try and find out more at work, but i dont want to ask too much to where i am letting them know that i may try to use the insurance for WLS. some companies dont like that from what i hear.

CMTurner · September 9, 2008

Ask HR or a fellow co-worker if you can perhaps look at the plan booklet "to see how they are going to cover dr's visits, etc" . It may show weight loss surgery to be an exclusion but, at least then you would know (sorta). Or you can try calling Cigna and telling them who you work for and ask if they cover bariatric surgery. It's worth a shot.