cigna

Hello,I,am hoping some one can help answer some questions I have.I have cigna insurance and they have a morbid obesity  clause but will pay for lap-band if mediacally nessasary.I have arthritis and fibromyalgia and have been totaly disabled for 13 years,I also have a medically watched weight loss clinic I attended for 7 months and a wellness center I have went to for 4 years to keep my self moving.Do you thimk I have a chance?My bmi is about 39.Thanks for any help

Cigna can be difficult about 90% of the time. So don't be surprised if you get denied even after meeting their requirements but that's not a reason to give up hope. Most of the time a denial is always a given and they will usually tell you why i. e., tests results missing, they missed something or some other requirement not fulfilled. Cigna has a coverage postion page and this is what it states: CIGNA HealthCare covers bariatric surgery using a covered procedure outlined below as medically necessary when ALL of the following criteria are met: • The individual is ,, 18 years of age or has reached full expected skeletal growth AND has evidence of one of the following: �� BMI (Body Mass Index) ,, 40 for at least the previous 12 months. �� BMI (Body Mass Index) 35–39.9 for at least the previous 12 months with at least one clinically significant comorbidity, such as a serious cardiopulmonary problem, Type 2 diabetes, hypertension, coronary artery disease, or pulmonary hypertension that has failed to respond adequately to appropriate medical management. • Active participation within the last two years in one physician-directed weight-management program for a minimum of six months without significant gaps. The weight-management program must include monthly documentation of ALL of the following components: �� Vital signs, including weight �� Current dietary program �� Physical activity (i.e., exercise program) �� Behavioral interventions to reinforce healthy eating and exercise habits �� Consideration of pharmacotherapy with U.S. Food and Drug Administration (FDA)- approved weight-loss drugs, if appropriate For individuals with lifelong, morbid obesity, participation in a program within the last five years is sufficient if documentation of six months is available and reasonable compliance with the weightmanagement program over an extended period of time can be demonstrated. However, diet programs/plans alone, such as Weigh****chers®, Jenny Craig® and similar plans, are not considered physician-directed weight-management programs and do not meet this requirement. Similarly, physician-directed programs consisting exclusively of pharmacological management are not sufficient to meet this requirement. • Recent evaluation by a multidisciplinary team including: �� A thorough medical history and physical examination. �� An evaluation by a licensed mental health care professional that specifically addresses any mental health or substance abuse diagnoses, the emotional readiness and ability of the patient to make and sustain lifestyle changes, and the adequacy of their support system. If an individual is already in behavioral health treatment, consultation with their treating clinicians should also be sought. �� A thorough nutritional evaluation by a physician or registered dietician experienced in the issues of bariatric surgery, who has had a meaningful conversation with the individual regarding the dietary and lifestyle changes required to ensure a successful outcome over time. Cigna has a coverage position page that is accessible to everyone. This coverage iposition  is valid if it's a covered benefit per your companies particular plan and if your company has not added their on stipulation. Otherwise, they just follow Cigna guidelines.  Hope this helps

        Thank you very much for the information.

No problem. Glad I can be of some assistance.

Hello Sweetiesmom, I, too, have CIGNA and I am having a revision from a failed SRVG to the Duodenal Switch on Oct. 3rd.  Originally CIGNA approved my revision surgery but they denied my choice of the DS.  They were more than happy to cover the RNY, which I do not want because I wanted the procedure with the highest percentage of weight loss and the lowest percentage of weigh re-gain.  I had to fight with them for 8 months before I was finally approved for the DS through an external review with an outside company.  Be sure to follow their guidelines to a T and you should be approved.  Yes, they will drive you crazy and make you jump through hoops, but they do that hoping you will get tired of their **** and give up.   Good luck.