Weight loss surgery is covered by most Cigna insurance. Some coverage plans, however, expressly prohibit bariatric surgery. To find out if your plan covers weight reduction surgery, contact Cigna directly.
Cigna and Great West Healthcare recently merged. The following is also true for Great West Healthcare.
How long does it take for insurance to cover gastric sleeve?
A growing number of states have approved legislation requiring insurance companies to provide weight-loss surgery for people who fulfill the NIH surgical requirements. While weight-loss surgery is commonly covered by insurance, the approval process can be lengthy and confusing. Working with your surgeon and other professionals gives you the best chance of getting insurance coverage approved.
Steps to obtain insurance coverage for bariatric surgery:
- Most insurance companies are aware of the health risks associated with obesity and will cover the costs of surgical weight loss in qualified patients. Every insurance plan, however, is unique.
- We begin the process of obtaining insurance authorization once you have completed our preparatory program, satisfied all of your insurance company’s requirements, and the surgeon has cleared you for surgery. We start by submitting your medical records to your insurance company, requesting that they fund the procedure. The insurance company may take two to four weeks to react with a decision.
- Once we obtain permission or refusal from the insurance carrier, we will contact you. If the coverage is accepted, the patient is given a surgery date and a pre-op appointment. If coverage is refused, we investigate the cause for the decision and file an appeal with the insurance carrier.
How do I get Cigna to approve gastric sleeve?
Pre-approval Requirements for Cigna
- A BMI between 35 and 40, as well as at least one severe comorbidity, such as Type 2 Diabetes. Cholesterol levels are high. Heart disease is a serious condition. Hypertension of the lungs. Obstructive Sleep Apnea (OSA) is a type of sleep apnea.
Does Cigna Cover skin removal after weight loss?
If the weight loss is due to bariatric surgery, the operation for excision of excess skin should be delayed until at least 18 months following the surgery and only when the weight has remained constant for at least the last six months.
Does Cigna Cover Stomaphyx?
Although the majority of Cigna’s insurance policies cover weight loss surgical treatments, some benefit plans specifically exclude them. If you’re unsure whether your plan covers surgical procedures for weight loss, contact Cigna directly to find out.
All of the following weight loss surgery standards and conditions for Cigna health insurance policies also apply to Great West Healthcare, which Cigna recently merged with.
Unless you have a policy that expressly states that weight reduction surgery is not covered, surgery will be covered if you fulfill Cigna’s particular conditions. All of the following requirements must be met:
- You must have documented proof of a BMI greater than 35 and a serious comorbidities. The following are examples of qualifying comorbidities:
- You must demonstrate that previous weight loss programs have failed. This entails enrolling in a weight-loss program that is medically supervised. Monthly documentation of your nutritional program, activity routine, and weight will be required to demonstrate that weight loss surgery is medically essential.
- You’ll need formal confirmation from your primary care physician that weight-loss surgery is being recommended.
- You’ll also need to have a psychological evaluation to ensure that you’re ready to make the necessary lifestyle changes to lose weight after weight reduction surgery.
Regular filling of your band to alter its tightness and your capacity to lose weight is a part of receiving a Lap Band or Realize Band. If Cigna covers and pays for your gastric banding treatment, they’ll also cover the necessary band fills while you’re getting used to it.
Some surgical methods for weight loss are not covered by Cigna. These are some of them:
If you have one weight loss surgery operation and don’t get the results you want, Cigna could be willing to pay for a second procedure. The operation must be declared unsuccessful by Cigna, which means you must be unable to decrease 50 percent of your excess body weight after the treatment.
It’s important to remember that “extra body weight” refers to the amount of weight you need to shed, not your overall body weight.
Cigna does not have many restrictions on where you can have your weight reduction surgery, however picking an in-network practitioner is usually the best option. When you choose an in-network surgical provider, you will have lower out-of-pocket charges, which means you will spend less overall for this surgery. Make sure you speak with Cigna directly to learn what forms of weight loss surgery are and are not covered, as well as whether you qualify. The sooner you start documenting your weight loss journey, the sooner you’ll be able to have the weight loss surgery you require.
Certain basic tests are done prior to surgery:
About 20 blood chemical values are returned by the chemistry panel. A gallbladder ultrasound is often requested by surgeons to check for gallstones.
How do I get approved for weight loss surgery?
You must meet the following criteria to be considered for weight-loss surgery:
- Have a BMI of 40 or more, or a BMI of 35 to 40 and an obesity-related ailment, such as heart disease, diabetes, high blood pressure, or severe sleep apnea.
- Weigh fewer than 450 pounds, which is the maximum weight allowed by hospital imaging equipment. A nutritionist can assist you if you need to lose weight to meet this criteria.
- Check to see whether your health insurance will fund bariatric surgery at UCSF if certain criteria are satisfied. Please be aware that we only accept Medi-Cal patients who are residents of San Francisco County.
How long does it take for Cigna to approve a surgery?
Your insurance carrier will either approve or deny your prior authorization request within 5-10 business days of receiving it.
Does Cigna Cover Weight Watchers?
CIGNA Healthy Rewards gives you exclusive discounts on programs and services that will help you improve your health and wellness. Weight Watchers, Jenny Craig, Pearle Vision, Bally Total FitnessTM, Curves, drugstoreTM, and more brands are among the offers. Good health is a reward in and of itself.
How much is gastric sleeve surgery?
Gastric sleeve surgery costs an average of $9,350. 1 Anesthesia, the hospital facility charge, surgeon’s costs, pre-operative lab and X-ray fees, and follow-up treatment are usually included in this cost. Keep in mind that the cost of your surgery will vary based on your surgeon, the location of the practice, and the number of days you need to stay in the hospital. Consultations with a dietician or nutritionist can cost anywhere from $70 to $100 per appointment, however the initial consultation may be more expensive. 2
Does insurance cover gastric sleeve surgery?
If you’ve been unable to lose weight through diet and exercise because of a medical issue, such as sleep apnea or heart problems, certain health insurance companies may pay all or a portion of the cost of gastric sleeve surgery. In most circumstances, you’ll need to have medically necessary weight loss surgery due to established health difficulties associated to being overweight.
Out-of-pocket costs for a sleeve gastrectomy for patients with insurance coverage can include deductibles, coinsurance, and copays. Your weight reduction surgery charges may be paid by your Medicare plan if you’re covered by Medicare and fulfill certain requirements. 3
Because some health insurance policies do not cover bariatric surgery, it’s a good idea to double-check with your provider. Even if your insurance doesn’t cover the cost of gastric sleeve surgery, many of the associated costs, like as lab testing, pre-op exams, and other pre-op prerequisites, may be covered.
How can I finance and pay for gastric sleeve surgery?
Some bariatric surgeons and hospitals offer payment plans, so inquire with your doctors about the possibility of paying for your sleeve gastrectomy expenditures in installments. A credit card can also be used to pay for weight loss surgery.
Does Cigna pay for labiaplasty?
Labiaplasty is not covered by Cigna since it is considered aesthetic rather than medically required. For details on the labiaplasty operation as part of initial gender reassignment surgery, please see the Cigna Coverage Policy for Gender Reassignment Surgery.