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What Are The Requirements Defined By Cigna For Weight Loss Surgery

Most Cigna policies will cover weight loss surgery. But, some plans will exclude the bariatric surgery. Keep in mind that Cigna and Great West Healthcare recently merged so coverages apply to both companies.

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What Are The Pre-Approval Requirements For Cigna

Unless your policy specifically excludes weight loss surgery, it will be covered so long as the following criteria are met:

  • 1 – 18 years old or older
  • Reached anticipated skeletal growth

And, as any of the following conditions:

  • 40+ Body Mass Index (BMI) 35+ BMI with at least one additional condition”
  • Obstructive sleep apnea
  • Pulmonary hypertension
  • Heart disease
  • High cholesterol
  • Type 2 diabetes
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Doctor Supervised Weight Loss Program

You will also need to show proof of failed doctor-supervised weight loss programs. The program will need to include monthly documentation of the following things:

  • Weight
  • Exercise program
  • Nutritional program

You will need to get evaluated by your primary care physician and bariatric surgeon to ensure that you do, in fact, need the weight loss surgery. You will also need to undergo a mental health evaluation and nutritional evaluation from either a registered dietician or doctor.

Four Kinds Of Bariatric Surgeries Cigna Covers

  1. Duodenal switch
  2. Gastric bands (either the Realize Band or the Lap Band)
  3. Gastric bypass
  4. Vertical banded gastroplasty

Cigna will cover any necessary lap band fills

What Procedures Are Not Covered

  • Biliopancreatic diversion (without the gastric band)
  • Fobi-pouch
  • Gastric bypass along with the gastric band
  • Intra-gastric balloons
  • Loop gastric bypass
  • Natural orifice surgery
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Are Second Weight Loss Surgeries Covered (Revisions)?

In cases where the lap band fails from the first procedure, a second weight loss surgery can be done and paid for.

WHAT DOES IT MEAN BY FAILED?

It is the failure to not loss more than 50 percent of your body weight.

Do You Need To Go To A Center For Excellence?

Currently, Cigna does not require the COE. Can You Choose An In-Network or Out-Of-Network Bariatric Surgery. You may have higher expenses with an out-of-pocket doctor but you don’t have to pick an in-network doctor if you do not want to.

However, take a look at your policy to be sure. If you have questions about the coverage for weight loss surgery with Cigna, call them at 1-800-244-6224 anytime of the day or night.

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