State of GA Employees Cigna HRA & High Deductible Guidelines for wls

Sorry to bore you non state employees and shbp post ops, but open enrollment is here for us state employees again, and since we have a new group coming to join us on the loser's bench next year, we need to show them the same care and guidance we veterans received. 

Here are the Cigna Guidelines for wls and a list of approved wls surgeons.  If you have a particular surgeon in mind, or if you live outside of Metro Atlanta it is important to check this list to see if your preferred surgeon or hospital is on the list.  Cigna and United Healthcare cover different surgeons and hospitals.   I elieve Cigna has more options for South GA and North GA unless UHC has added some more hospitals.

We DO NOT have out of network coverage for wls, so if you do not see the doctor or hospital on the list you cannot under any cir****tances get your surgery fom them.  You need to see if they are covered by UHC or select a different surgeon. 

Once open enrollment is over, you won't be able to switch to a different insurance.

 

 

Cigna Approved Hospitals

Atlanta Medical Center  - Atlanta
Celio Burrowes
Titus Duncan
Clarence Hixon
Larry Hobson
Quammar Rashid (I believe she moved to DeKalb Medical)
 
 

Emory Crawford Long - Atlanta
S. Scott Davis
Charles R. Finley
Edward Lin
John Sweeny
Jahnavi Srinivasan



Northside Hospital - Atlanta
Christopher Hart
Paul Macik


Hamilton Medical Center - Dalton
Richard F Fromm
Steven Paynter
Jaime Ponce


Dekalb Medical- Decatur
Scott D Steinburg


Emory John's Creek - John's Creek
Paul Macik
William Johnson
Ahad Khan
Christopher Hart


Floyd Medical Center - Rome
John R Scott


Memorial Health University Medical Center - Savannah
John D Angstadt
Oliver Whipple





***  If I have left someone off, please let me know so I can edit the list.

These are the steps you'll need to complete before your surgeon submits to Cigna for approval for your surgery.  These are for Cigna State of GA employees only. Other Cigna members that are not state employees may have a diffferent set of requirements.

 

Georgia State Health Benefit Plan

Bariatric Surgery

Requirement Check List

Coverage of Bariatric Surgery is available for

coverage under the HRA and HDHP plan options only

course of treatment per lifetime.

the terms and conditions of coverage.

Bariatric surgery is covered when ALL of the following medical necessity criteria and requirements are met:

eligible State Health Benefit Plan members with Primary SHBPand is limited to ONE bariatric surgical procedure andPlease refer to the applicable HRA or HDHP benefit plan document to determine

Check

List Requirement Instruction

1.

that you are requesting information on Bariatric Surgery

requirements and may want to pursue authorization for this

service once all requirements are met.

Call CIGNA HealthCare. Advise the Customer Service Associate

Call

the Medical prompt and then Authorization

prompt. Advise the Customer Service Associate

that you are requesting information on

Bariatric Surgery requirements and may want

to pursue authorization for this service once all

requirements are met. The Customer Service

Associate will take your information and open a

Case Management Request.

A Case Manager will be assigned and will call

you to review requirements in detail and direct

you accordingly.

the number on your ID card and follow

2.

Centers of Excellence which is contracted with CIGNA HealthCare

and on our Centers of Excellence list.

For a listing of the Bariatric Surgery Centers of

Excellence which are contracted with CIGNA

HealthCare go to:

The bariatric surgery MUST be performed at a Bariatric Surgery

http://www.cigna.com/js/partner/bni/bariatric.pdf

3.

age

evidence of one of the following:

a. BMI (Body Mass Index)

(must be documented in your physician’s medical records); or,

b. BMI (Body Mass Index) 35–39.9 for at least the previous 24

months (must be documented in your physician’s medical

records) with at least one clinically significant comorbidity (must

be documented). (Comorbidities include but are not limited to,

cardiovascular disease, Type 2 diabetes, hypertension, coronary

artery disease, or pulmonary hypertension).

The individual must be greater than or equal to 18 years ofAND has reached full expected skeletal growth AND has≥40 for at least the previous 24 months

Your Physician

clinical information to CIGNA HealthCare

Medical Management Health Facilitation

Center by either fax or mail.

must submit all pertinent

Fax Information:

866.552.1124

Attention: CIGNA Medical Management HFC

Mail Information:

CIGNA

1111 Market Street

Chattanooga TN 37402

Attention: CIGNA Medical Management HFC

Check list continued on next page

Check

List Requirement Instruction

4.

including Biometric Screening. (Biometric Screening includes

measurements of; height, weight, blood pressure, blood sugar

level (blood glucose), and total cholesterol).

The individual must have completed the Health Assessment (HA)

Instructions for completion of CIGNA

HealthCare’s Health Assessment and

Biometric Screening are available at

http://www.cigna.com/sites/stateofga/

rewardprogram.html

5.

Management Program Assessment Call or Health Advisor First

Coaching Session upon completion of the HA. Engagement

is further defined as having actively completed the Health

Advisor intake assessment process.

for ongoing participation in these programs, though SHBP

members are encouraged to utilize these resources.

The individual must engage with CIGNA HealthCare’s LifestyleThere is no requirement

Complete

submit the Biometric Screening attestation as

instructed above.

the Health Assessment and

Call

the Medical and then Nurse Advisor prompts

to

Assessment Call or Health Advisor First

the number on your ID card and followschedule a Lifestyle Management Program

Coaching Session.

6.

within the last two years in one physician-supervised weightmanagement

program for a minimum of six months without

significant gaps. The weight-management program must include

monthly documentation of ALL of the following components:

weight, current dietary program and physical activity (e.g.,

exercise program).

(Programs such as Weigh****chers®, Jenny Craig®

and Optifast®

are acceptable alternatives if done in conjunction with physician

supervision and detailed documentation of participation is

available for review. For individuals with long-standing, morbid

obesity, participation in a program within the last five years is

sufficient if reasonable attendance in the weight-management

program over an extended period of time of at least six months

can be demonstrated.

consisting exclusively of pharmacological management are not

sufficient to meet this requirement).

The individual has documented evidence of active participationHowever, physician-supervised programs

Your Physician must submit

clinical information to CIGNA HealthCare

Medical Management Health Facilitation

Center by either fax or mail.

all pertinent

Fax Information:

866.552.1124

Attention: CIGNA Medical Management HFC

Mail Information:

CIGNA

1111 Market Street

Chattanooga TN 37402

Attention: CIGNA Medical Management HFC

 

List Requirement Instruction

Check

 

 group for a minimum of 6 months prior to authorization of

surgery. Participation must be at a location, approved by your

physician, which may include, but is not limited to, a Bariatric

Centers of Excellence contracted with CIGNA HealthCare. SHBP

Members must attend a bariatric support group at least once per

month for 6 consecutive months to meet this requirement.

 

group more often than one time per month if they desire - and

 

 

one meeting per month for 6 consecutive months to meet

 

received on or after 3/19/2009.

7.  The individual must participate in a bariatric surgery support      (SHBP Members may voluntarily attend the bariatric supportare encouraged to do so; however, they MUST attend at least   ). Requirement applies to ALL requests

Complete and submit

below

included with his/her clinical information

submission.

The form must be completed in detail including

contact information.

Maintain a copy for your records.

You may also submit the form directly to CIGNA

HealthCare Case Management by faxing to:

866.552.1124

Attention: CIGNA Medical Management HFC

Or mail to:

1111 Market Street

Chattanooga TN 37402

Attention: CIGNA Medical Management HFC

the form attachedto your Bariatric Surgeon to be

 

8. The individual has undergone an evaluation by a multidisciplinary a separate medical evaluation recommending bariatric surgery

b.

recommending surgical treatment

an evaluation by a surgeon qualified to do bariatric surgery

c.

the individual has no underlying untreated psychological/

behavioral issues that could interfere with the individual’s ability

to comply with the behavioral changes required as a result of

the bariatric surgery. (If the mental health evaluation identifies

potential psychological/behavioral issues that are untreated, the

individual must participate in ongoing psychological/behavioral

health counseling treatment to address those untreated issues.

There must be documentation from the individual’s mental

health provider indicating that such untreated psychological/

behavioral issues have either resolved or have been adequately

treated so that they no longer pose a risk to a successful bariatric

surgery outcome and clearing the individual for bariatric

surgery.)

clearance for surgery by a mental health provider indicating

d.

dietician or nutritionist.

a nutritional evaluation by a physician or registered/licensed

 

medical team within the previous 12 months which

includes all of the following:

a.

this requirement 

The requirement list came out a little weird, To access it directly from Cigna. Please follow these steps:


1. Go to http://www.cigna.com/sites/stateofga/index.html  <---- click here


2. Under the green Welcome SHBP Members. click on the blue   
                  Resources for Active Employees

3.  The 6th selection on the list is  {A } Bariatric Surgery (PDF). Click on this.


These are the official Cigna shbp  requirements for you to get your surgery.
Print it out and take it to your consult appt with your surgeon and give a copy to your pcp at your 1st diet visit.

As long as you do everything on the list you should have no problems getting your surgery approved.

I met a lady who works for Henry county school system.... is she covered under the State plan? If your a teacher does it matter what county you work for or are u state covered?

Thanks

CC

Doesn't matter what county. All public school teachers are state employees.   Just make sure she chooses the HRA or High Deductible plan.