Cigna – Requirements for Weight Loss Surgery
Most policies with Cigna cover weight loss surgery. However, some benefit plans do specifically exclude bariatric surgery. Contact Cigna directly to find out if your plan includes weight loss surgery coverage.
Cigna recently merged with Great West Healthcare. The following applies to Great West Healthcare as well.
Cigna Pre-approval Requirements
Unless weight loss surgery is specifically excluded from your policy, surgery is covered if the following criteria are met:
The individual is at least 18 years of age or has reached full expected skeletal growth AND has evidence of EITHER of the following:
- A Body Mass Index (BMI) of 40 or greater.
- A Body Mass Index between 35 and 40 with at least one significant comorbidity that may include:
- Type 2 Diabetes
- High Cholesterol
- Heart Disease
- Pulmonary Hypertension
- Obstructive Sleep Apnea
You must also show that other methods of medically supervised weight loss programs have failed.
The medically supervised weight management program must include monthly documentation of ALL of the following:
- nutritional program
- exercise program
An evaluation from a bariatric surgeon and your primary care physician with a resulting recommendation for surgery is necessary. A mental health evaluation is required as well as a nutritional evaluation from a physician or registered dietitian.
Types of Weight Loss Surgeries Covered By Cigna
- Gastric bypass
- Gastric bands (Lap Band or Realize Band)
- Duodenal switch
- Vertical banded gastroplasty
- Gastric sleeve surgery
If you’re unsure which procedure is right for you, take our test.
Are lap band fills covered?
Yes, Cigna covers lap band fills as necessary.
Procedures excluded from coverage
- Gastric bypass combined with a gastric band
- Biliopancreatic diversion without a duodenal switch
- Loop gastric bypass
- Intra-gastric balloons
- NOTES – natural orifice surgery (Stomaphyx, etc.)
Is a second weight loss surgery covered if lap band doesn’t work?
Yes, it is covered if the first procedure was unsuccessful. An unsuccessful procedure is defined as a failure to lose 50% of excess body weight.
Does Insurance Company Require Center of Excellence?
Cigna does not appear to require a COE designation at this time.
Do I have to use an In-Network Bariatric Surgeon?
While your out-of-pocket expenses may be higher, you do not need to choose an in-network provider. Individual policies may vary.
Cigna’s Contact Info to Inquire About Surgery
For questions on Benefits with Cigna call: 1.800.CIGNA24 (1.800.244.6224) (available 24/7)
Cigna’s Weight Loss Surgery Full Coverage Statement
Cigna’s full bariatric surgery coverage statement can be found here.