I have Aetna, but even different people within Aetna have different policies. 

Your insurance company will likely have the requirement for a doctor-supervised diet prior to surgery approval.  Alternatively, your surgeon might have his own requirement.  For instance, one of the top surgeons here has a requirement that all his patients participate in a specific diet-class-exercise regimen/program prior to surgery.  This could also be used to meet the insurance requirement.  However, some of his patients have done the insurance requirement first, on their own, and it was not a strict enough program, so the surgeon made them do it all over again. 

If you go to a consult, likely the surgeon's office will have an insurance coordinator on staff who knows the ins and outs of what is specifically required for you.  And then they can help you navigate those waters.  Good luck.  It can be a frustrating journey, yet so worth it.

But that is what I am asking - what is your BMI (or height and weight)?  If it is over 40, then it probably is covered by insurance, even though there may be steps you need to take to ensure you qualify (a 6-month doctor supervised diet, exercise regimen, etc.)  If it is between 35-40, it might be high enough if you have 2 comorbidities (whatever BCBS says are comorbidities). 

I would go for a consult and see what a WLS clinic has to say.  They are the ones that might know how to submit to your insurance correctly.  It all comes down to what your physical insurance policy says.  I have never had to deal with my insurance company - my surgeon did it all for me.

Does anyone know how good Cigna PPO insurance is and also how hard is it to get approved for surgery with them? Did they require anything crazy?

Sorry no one has answered you yet.  It really depends on your insurance.  Did they pay for the first one?  Some policies exclude any and all WLS, and some are a once-per-lifetime type of policy.  Some cover revisions if medically necessary.  And it will depend on the reason for the revision - you might have to show that the revision is needed NOT due to your failure to follow post-surgery instructions.

I own my own small business and have been told by my insurance agent that none of the individual or small business plans will cover it. I'm not willing to give up that easily. I know that BC/BS of LA will not cover ANYTHING related to obesity (as I see patients and have been denied payment if I write obesity on the bill). But I also have patients with UHC, Aetna, Humana, to name a few who have been able to get bariatric surgery.  So keep looking and keep asking, I know I will.