MY BMI IS TOO LOW TO GET DS WITH DR K

Dr. K said he will do my revision, i have a $0 copay.  He has a $4000 program fee but CIGNA will not approve it if I don't have a BMI of at least 50?????

Get ahold of your policy. Read it for yourself. No one cares about this more than you, right? Do not trust info over the phone from company employees.

And make sure you read the portion about revisions, not primary bariatric procedures, AND consider whether or not you have anything technically wrong from your old surgery or are living with complications that may qualify you for revision regardless of your bmi.

Larra

I know this is a stupid question but where exactly would you get a copy of your detained health benefits. I looked on the website under bariatric coverage it just said basically yea its covered and there is a $500 copay if I hadn't met my deductible.

you should be able to get your subscriber agreement from your HR dept. or from you insurance co.

Yea thanks I already found it on line and am looking through it now.

great glad you found it

 

50 BMI? I thought the unwritten rule of thumb was 40. I was at 39 when I had my surgery. I think it also depends on things like high blood pressure, cholesterol, sleep problems, ect....

I am already approved for WLS --Sleeve but the lady at Dr. K's office said that CIGNA requires for the DS you to have a BMI of 50.  That means I would have to be 20lbs(246)  heavier than I am 226. I usually have light close on when it comes to weighing but you can beat your butt Im going to have jeans and weight with shoes and everything else I can find to go in my pockets the next time I get on a scale.

I have Cigna, too, and was afraid of the BMI of 50 rule, but it was never an issue. I think since you are a revision, that the criteria is a little different or something. They did deny me at first, but not for that, and approved it the second time around.

Obesity/Bariatric Surgery

Treatment of clinically severe

obesity, as defined by the body mass

index (BMI)

Waiting Period:

One year from date of Initial

Employment (to be verified by

Maricopa County)**

The following are excluded

▪ Medical and surgical services to alter

appearances or physical changes that

are the result of any surgery performed

for the management of obesity or

clinically severe (morbid) obesity.

▪ Weight loss programs or treatments,

whether prescribed or recommended by

a physician or under medical

supervision.

Note: Mental Health coverage is

carved out to Magellan. Any

necessary Mental Health evaluations

required for prior authorization need

to completed with Magellan Benefits.

For additional questions contact Cig

This is all my cigna policy says about bariatric surgery: