Cigna Requirement for Weight Loss Surgery
Most of the insurance policies offered by Cigna do cover weight loss surgical procedures, but there are some benefit plans that specifically exclude it. If you are not sure whether or not your particular plan includes surgical procedures for weight loss, make sure that you contact Cigna directly to find out.
All of the following requirements and criteria for weight loss surgery under Cigna health insurance plans also apply to Great West Healthcare, a provider that Cigna recently merged with.
Requirements for Pre-Approval of Weight Loss Surgery with Cigna
Unless you have a policy that specifically excludes weight loss surgery, surgery is going to be covered provided that you meet specific criteria set forth by Cigna. These requirements include all of the following:
- You need to be at least 18 years old,
- You need to have reached your expected skeletal growth,
- You need to have documented evidence of a BMI exceeding 40, or
- You need to have documented evidence of a BMI exceeding 35 with a significant comorbidity. Qualifying comorbidities include:
- Type 2 diabetes,
- Heart disease,
- High cholesterol,
- Pulmonary hypertension,
- Obstructive sleep apnea.
- You need to show that other weight loss programs have failed in the past. This involves attending a medically supervised program for weight loss. This will include monthly documentation of your nutritional program, your exercise program and your weight to show that weight loss surgery is medically necessary.
- You need written documentation that your primary care physician is recommending surgery for weight loss.
- You will also need to undergo a psychological evaluation in order to make sure that you are ready to make the requisite lifestyle changes for weight loss following weight loss surgery.
What Weight Loss Procedures Does Cigna Cover?
The procedures that Cigna generally covers will include all of the following.
- Gastric bypass procedures,
- Gastric banding procedures, (Lap Band, Realize Band, band fills)
- Vertical banded gastroplasty,
- Duodenal switch,
- Gastric sleeve procedures.
Part of getting a Lap Band or Realize Band entails regular filling of your band to adjust its tightness and your ability to lose weight accordingly. If Cigna covers and pays for your gastric banding procedure, then they will also cover the required band fills while getting used to your band.
Procedures Cigna Does Not Cover
There are some weight loss surgical procedures which Cigna does not cover. These include:
- Gastric bypass when combined with a gastric band,
- Biliopancreatic diversion sans duodenal switch,
- Intra-gastric balloons,
- Loop gastric bypass,
- Natural Orifice Surgery (such as Stomaphyx)
If you go through with one weight loss surgical procedure and do not achieve the desired results, Cigna may be willing to cover a secondary procedure. Cigna’s primary requirement is that the surgery is deemed unsuccessful, which means that you are unable to lose 50% of your excess body weight after the procedure.
Remember that “excess body weight” is defined as the weight that you need to lose, not your total body weight.
Cigna does not have many requirements as to where you need to go to have your weight loss surgery, but choosing an in-network provider is generally your best course of action. When you choose an in-network surgical provider you will find lower out-of-pocket costs, meaning that you will pay less in the end when it comes to this type of procedure. Make sure that you consult Cigna directly to find out what types of weight loss surgery are and are not covered, and to determine whether or not you qualify. The sooner you begin to document your weight loss journey, the sooner you can undergo the weight loss surgery that you need.
6 thoughts on “Cigna Requirement for Weight Loss Surgery”
Hello My name Is Crystal I weigh 318.8 lbs and been looking to see if you cover weight loss surgery my BMI is 58.1. Im a type 2 Diabetic and just looking for some options I have tried alot of different diets and nothing has happen.
does cigna require a certain A1 C in order to get preapproval
Hello im 53 and my BMI is 32, but i have stage 4 hypertension, very high cholesterol, im pre diabetic and have mito value prolapse, and sleep apena my oxygen get down in the 70s and 80s at night. I have severe back problems and my weight makes it worse. Will i qualify
I have back problems and a sleeping disorder where I stop breathing for an extended amount of time during the night and tired all the time so I’m wanting to see about the lapband surgery or the sleeve, I’ve tried all diets and just can’t get it off.
I’m 5ft 187Ib bmi 37
I have irregular heart beat so I take blood pressure medicine. I have acid reflex. And anxiety. I’m too heavy for my height. And can’t drop it since my last child. They have that I’m comorbesity on my doctors note since 2021.
Could this be approved?? Also….
I see that it says if I was asian I could with a bmi of 37 . Could I appeal that?
Your first step would be to fill out a health questionnaire with our collaborative partner, Mexico Bariatric Center. It’s free and confidential. They will be able to determine if you qualify based on your medical history. Normally for severe acid reflux, gastric bypass is recommended.