My employer is switching from BCBS to Cigna in Jan. My dr's office secretary told me that Cigna requires more "hoops" to jump thru than BCBS. I don't know if I will have all the prereqs done by the end of the year. I'd appreciate any advice on experience with Cigna and LB surgery approval.

My employer is switching from BCBS to Cigna in Jan. My dr's office secretary told me that Cigna requires more "hoops" to jump thru than BCBS. I don't know if I will have all the prereqs done by the end of the year. I'd appreciate any advice on experience with Cigna and LB surgery approval.

I currently have CIGNA Pos not Cigna PPO and all I had to pay out of pocket was $100 dollars and they paid the rest. They did require me go do the 6 months of Dr. visits and just look at my signature and those are the things that they required of me but it was all worth it. Good Luck

Thanks. I don't want to rush myself into surgery at this point.

Here you go right out of Cigna website. I hope it helps!

CIGNA HealthCare covers bariatric surgery using a covered procedure outlined below as

medically necessary when ALL of the following criteria are met:

• The individual is ≥ 18 years of age or has reached full expected skeletal growth AND has

evidence of one of the following:

BMI (Body Mass Index) ≥ 40 for at least the previous 24 months.

BMI (Body Mass Index) 35–39.9 for at least the previous 24 months with at least one

clinically significant comorbidity, including but not limited to, cardiovascular disease, Type 2

diabetes, hypertension, coronary artery disease, or pulmonary hypertension

• Active participation within the last two years in one physician-supervised weight-management

program for a minimum of six months without significant gaps. The weight-management program

must include monthly documentation of ALL of the following components:

Page 2 of 34

Coverage Position Number: 0051

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 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.

CIGNA HealthCare does not cover the following bariatric surgery procedures, because they are

considered experimental, investigational or unproven (this list may not be all-inclusive):

• Fobi-Pouch (limiting proximal gastric pouch)

• intragastric balloon

• mini-gastric bypass

• sleeve gastrectomy (SG)

• Natural Orifice Transluminal Endoscopic Surgery™ (NOTES™) (e.g., StomaphyX™)

Thanks for the link to the Cigna website. Very much relieved...