Question:
I am trying to find out the current criteria that must be met for medical necessity.

I have Cigna POS, and I am trying to find out what they require to meet medical necessity.    — Sherry Y. (posted on August 30, 2002)

August 30, 2002
Each insurance compnay sets their own guidlines so may need to call them and ask. I have CIGNA but it is a HMO. My critia was 1.) must have a BMI of over 40 for the apst 5 years. 2.) have gone through at least 3 supervised weight loss programs with one of them being in the past years and each lasting for 3 months or more. I also had to go through Nutritionist counseling for 3 months. (Thats why they keepo dening me until I completed it). It is also very helpful if you have other comorbities. Hope I helped.
   — Debbie W.

August 30, 2002
You must have a BMI that exceeds 40 for over a year OR, if your BMI is between 35 and 40, AND you have one or more significant co-morbs which have not responded to other treatment methods AND you are between the ages, ideally, of 18 and 60 AND you are able to document that consistent reasonable efforts have been made by a physician to manage your co-morbs. If you are a substance abuser, are pregnant, or have a sever psychatric disorder, you will not qualify. If you have an unstable medical condition, you will not qualify.
   — blessednblu