Cigna covers RNY but not DS

Hi,           Can anyone tell me why my insurance will cover RNY and not DS?  They say that DS is experimental, but I thought it has been around a while.  I appreciate any and all comments.                                                                                                                          Blessings

I am sorry I can't answer your question, but maybe you can help with mine.  I have Cigna too and they said that they do not cover ANY obesity surgery.  The sales rep that talked my husband's company into moving to CIGNA this year said that none of their insured plans cover any obesity surgery -- it isn't even offered as an option.  She did say that if the administer a health plan for a self-insured company then bypass would be covered if the company opts to do so.  Is your plan part of a self-insured plan? Sorry I couldn't answer your question.

Well my husband works for a very large engineering firm and we have Cigna Open Access Plus. Bariatric Sugery is covered under our plan as long as I meet all the criteria and take all the steps that they require.  I do know that every plan is different, but I don't believe it is self-insured.  I suggest calling Cigna and they will tell you if you are covered or not.  Good Luck                                                                                                                            Blessings                        

Just because they generally consider it experimental doesn't mean a firm denial. You and your doctor may have to work hard to make a clear case of why it's a better surgery for you than RNY, and you may have to appeal, but I say go for it if you truly feel it's the right choice for you.

In regards to what the sales representative told your husband, it is false.  I know several people who are covered under Cigna who are eligible for bariatric surgery.  in fact, my partner's employer, Verizon Wireless, offers coverage through Cigna, and that plan allows for bariatric surgery under specific incidences.  Verizon Wireless is not a self-insured company. In regards to duodenal switch, if your medical provider can demonstrate medical necessity for the procedure (over Roux-en-Y), then the insurance company will cover it.  The trick is submitting the right information to the insurance company.

I have Cigna Open Access Plus and they are allowing the surgery because it is medically necessary.  Get the code of the surgery that they use to bill fromt he surgeon and call Cigna ...that is what i did and they said it is covered.  Also, have you checked out the benefit plan in the small book that Cigna gives that lists the co-pays and all?  Well, on page 53 of mine is says the following:

(This is the exclusions and not covered part of the booklet? For medical and surgical services intended for the tratment of control of obesity, unless Medically Necessary. BMI must be over 40 or greater without co-morbidities, or 35-39 with comorbidities. So see, some Cigna plans do cover it.  They told me for 2 weeks that I was not covered and then I got the billing code from the surgeon (it is called a CPT code)