Cigna - Supervised weight loss criteria?

dealil10
on 6/1/20 12:18 pm

Anyone recently been approved for surgery with Cigna insurance? I am having issues getting specific timeline requirements for monthly documented visits to my doctor, showing attempted weight loss. I've called Cigna twice and received different answers both times. First, I was told a minimum of 6 months. Then, I called back the same day and was told monthly for 89 days. I'm frustrated that even when they are given my specific Cigna plan information (member id, group number, employer, all details....) they can not give me a consistent answer.

Their website actually no longer lists a timeframe and reads:

  • A thorough multidisciplinary evaluation within the previous six months whi*****ludes ALL of the following:

    • ? a description of the proposed procedure(s)

    • ? a recommendation for bariatric surgery from a physician/ physician's assistant/nurse practitioner

      other than the requesting surgeon or associated staff

    • ? unequivocal clearance for bariatric surgery by a mental health provider

    • ? a nutritional evaluation by a physician or registered dietician

Sparklekitty, Science-Loving Derby Hag
on 6/1/20 3:32 pm
RNY on 08/05/19

Call customer service and ask for the "coverage guidelines" document for bariatric surgery. Get the policy in writing.

Sparklekitty / Julie / Nerdy Little Secret (#42)
Roller derby - cycling - triathlon
VSG 2013, RNY conversion 2019 due to GERD. Trendweight here!

dealil10
on 6/1/20 5:00 pm

I've already called them twice and both times they have given me the information I pasted above. The insurance company has been useless.

NYMom222
on 6/1/20 6:13 pm
RNY on 07/23/14

I agree with Sparklekitty. Get it in writing. My insurance plan emailed me the portion of the document pertaining to WLS.

Cynthia 5'11" RNY 7/23/2014

Goal reached 17 months. 220lb Weight Loss
Plastic Surgery Dr. Joseph Michaels - LBL and Hernia Repair 2/29/16, Arm Lift, BL, 5/2/16, Leg Lift 7/25/16

#lifeisanadventure #fightthegoodfight #noregrets

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ladygodiva1228
on 6/2/20 9:57 am - Putnam, CT
Revision on 02/04/15

This is the most updated coverage WLS Cigna for Cigna.

Dr. Sanchez Lapband 9/12/2003
hw305/revision w280/cw197/gw150

Revision from Lap Band to Bypass on 2/4/2015 by Dr. Pohl

    

SuMari
on 6/2/20 3:29 pm

If you have your insurance through your employment, you may have a counselor or advocate who can turn to as well for questions like this. They can look at your specific policy and see what is covered

I am going through the process and it's a 6-month process and you must show that you can lose or maintain during that time on a supervised weight loss plan. I need to see a therapist at least twice and work with a nutritionist (or attend a class if the bariatric center provides it)

Dee_Caprini
on 6/2/20 3:40 pm

I had Cigna 12 years ago when I had my surgery. I had to go through 6 months of supervised weight loss visits (every 30 days) to my Primary Care Physician, I needed to have a heart monitor test (I think it is the EKG) to make sure my heart was strong, plus I had to do bloodwork. Then once I did my 6 months + tests, plus my doctor had to show that I had multiple co-morbidities (I had high blood pressure, sleep apnea, Swelling/water retention, migraines, knee and ankle issues, GERD/acid reflux issues, a hiatal hernia and considered super morbidly obese. I had to see a mental health pro/therapist once to clear me as well.

Once they sent all of that paperwork in to the insurance for my referral, I was referred I was denied at first, but I appealed because my PCP didn't send a few documents, cross T's and dot I's... and was approved. I saw my bariatric surgeon and from there they did another 3 months of monitoring and classes. That was through THEIR program, not required by insurance. I was sour about it at first, but in the end, it all made sense and I am better for it.

From there, my surgery was scheduled and I had RnY.

I am thankful for my work at the time for covering/allowing bariatric surgery and chose not to exclude it. You have to make sure YOUR SPECIFIC plan covers bariatric surgery.

(deactivated member)
on 6/2/20 7:35 pm

I went thru Cigna ins. Requirements 5 years ago. It was 3 months supervised Nutrionist consults. I gained about 7 pounds but went thru the process. Cigna denied the first dr request for approval, then denied 2ndrequest, and then approved. Start to finish was only about 5 weeks for all 3.

If your dr is persistent the ins co will approve after a few attempts. They don't want the liability of persistent rejections against dr recommendations.

Partlypollyanna
on 6/3/20 3:41 am
RNY on 02/14/18

Even within the same insurance company, the requirements can be different, depending on your policy (or your employer's policy). I found this first hand when I had an employer change mid process, same insurance company, different requirements.

As mentioned previously, getting your plan information in writing is what you need. Also, if your medical team includes a patient advocate or you have access to one through your insurance, that could help you get the information you need.

HW: 306 SW: 282 CW:144.8 GW: 145 (reached 2/6/19), next goal - 132.9

Jen

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