will cigna cover weight loss surgery

Navigating health insurance coverage for medical procedures can be a complex process, especially for significant interventions like weight loss surgery. As one of the leading health insurance providers, Cigna offers coverage for weight loss surgery, providing financial support to eligible patients seeking surgical treatment for weight-related health problems. This article will delve into the eligibility criteria, covered procedures, and application process, empowering individuals with the knowledge necessary to make informed decisions about their weight loss journey.

Eligibility Criteria for Cigna’s Weight Loss Surgery Coverage

To determine eligibility for Cigna’s weight loss surgery coverage, patients must typically meet the following criteria:

  • Body Mass Index (BMI) of 40 or higher
  • Presence of an obesity-related health condition, such as diabetes or heart disease
  • Documentation of unsuccessful attempts at non-surgical weight loss methods

Covered Weight Loss Surgery Procedures

Cigna covers several weight loss surgery procedures, allowing patients to choose the option that best meets their individual needs and circumstances. The covered procedures include:

  • Gastric Sleeve Surgery: A restrictive procedure that removes a large portion of the stomach, limiting food intake and promoting weight loss.
  • Gastric Bypass Surgery: A combined restrictive and malabsorptive procedure that reroutes food intake to a smaller stomach pouch, bypassing a portion of the intestine and reducing absorption.
  • Laparoscopic Adjustable Gastric Banding (Lap-Band): A less invasive procedure that involves placing an adjustable band around the upper part of the stomach, regulating food intake through adjustments made over time.

Pre-Authorization and Application Process

Before undergoing weight loss surgery, patients must obtain pre-authorization from Cigna. The process typically involves submitting a request for medical necessity review. This request should include medical records, a detailed account of previous weight loss attempts, and a letter from a qualified bariatric surgeon supporting the need for surgery.

Cost Considerations and Patient Responsibility

While Cigna covers weight loss surgery, patients may have some out-of-pocket costs to consider, such as:

  • Deductibles: A fixed amount that must be paid before insurance coverage begins
  • Co-payments: A set amount paid for specific medical services, such as doctor visits or surgery
  • Coinsurance: A percentage of the medical expenses that the patient is responsible for paying

The specific costs and patient responsibility will vary depending on the individual’s health insurance plan.

Additional Resources for Patients

For further guidance and support, patients can access the following resources:

These resources provide comprehensive information on weight loss surgery, Cigna’s coverage policies, and support groups for individuals considering or undergoing surgery.

Making an Informed Decision

Understanding Cigna’s coverage for weight loss surgery empowers patients to make informed decisions about their healthcare. By meeting eligibility criteria, following the pre-authorization process, and considering the associated costs, individuals can navigate the complexities of insurance coverage and take a proactive approach to improving their health and well-being.

By partnering with Cigna, patients can access the necessary financial support and medical expertise to embark on their weight loss journey confidently and effectively.