Understanding Coverage for Weight Loss Surgery with CIGNA
If you’re considering weight loss surgery, understanding your insurance coverage is crucial. Cigna’s coverage for bariatric surgery varies based on your plan.
Key Points:
- Coverage depends on your specific Cigna plan and state regulations.
- Roux-en-Y gastric bypass, sleeve gastrectomy, and adjustable gastric banding are generally covered.
- Excluded procedures include Fobi-pouch and single-anastomosis DS.
- Coverage for panniculectomy and abdominoplasty varies.
- Some weight loss medications may be covered with prior authorization.
Eligibility Criteria for Weight Loss Surgery with CIGNA
To qualify for Cigna’s weight loss surgery coverage, you typically need to meet certain criteria:
- Body Mass Index (BMI) of 40 or higher, or 35 or higher with related health issues.
- Unsuccessful attempts at other weight loss programs under doctor’s supervision.
- No history of substance abuse or mental health issues.
Navigating the Coverage Application Process for Bariatric Surgery with CIGNA
- Check Eligibility: Ensure you meet Cigna’s requirements based on BMI, medical history, and weight loss attempts.
- Gather Documents: Collect medical records, physician’s referral, and proof of previous weight loss efforts.
- Start Application: Contact Cigna to initiate the application process. Provide accurate and complete details.
- Get Pre-Approved: Cigna will review your application and determine your coverage eligibility. You’ll receive a pre-approval letter if approved.
- Schedule Surgery: Once pre-approved, schedule your surgery and adhere to post-operative instructions.
- File Appeal (if Needed): If coverage is denied, provide additional medical evidence to support the necessity of the surgery.
By following these steps, you can increase your chances of securing coverage for weight loss surgery with Cigna.