Does this mean what I think it means?
Based on what I found in my Cigna booklet, am I correct in thinking that there is NO way I can be approved for any kind of weight loss surgery through them? -
Benefit Limitations-
for medical and surgical services, initial and repeat, intended for the treatment or control of obesity including clinically severe (morbid) obesity, including: medical and surgical services to alter appearance or physical changes that are the result of any surgery performed for the management of obesity or clinically severe (morbid) obesity; and weight loss programs or treatments, whether prescribed or recommended by a Doctor or under medical supervision.
Benefit Limitations-
for medical and surgical services, initial and repeat, intended for the treatment or control of obesity including clinically severe (morbid) obesity, including: medical and surgical services to alter appearance or physical changes that are the result of any surgery performed for the management of obesity or clinically severe (morbid) obesity; and weight loss programs or treatments, whether prescribed or recommended by a Doctor or under medical supervision.
It does sound like it's probably an exclusion, but I would be curious to know the context. My insurance is worded similarly in the it says that it says surgery to primarily treat morbid obesity is not payable. At first, it sounds like they won't cover it, but it goes on to say it is payable in the presence of morbid obesity and particular co-morbidities which will benefit from surgery treatment. Can you copy and paste more of that section, possibly?
Disclaimer: I don't work in insurance, but I was employed as a worker's compensation medical biller, and specialized in appeals.
Disclaimer: I don't work in insurance, but I was employed as a worker's compensation medical biller, and specialized in appeals.
Keep reading! I have Cigna too and mine also says that WLS is excluded....yada yada yada.....UNLESS MEDICALLY NECESSARY. I had to even help the surgeon's office read the policy correctly. Read it again!
Pre-band highest weight: 244
Pre-band surgery weight: 233
Lowest: 199 ( for, like, a day)
CW: 260 (yes, with the band!)
Current Fill: 5cc in 10cc band
BMI: 49
Pre-band surgery weight: 233
Lowest: 199 ( for, like, a day)
CW: 260 (yes, with the band!)
Current Fill: 5cc in 10cc band
BMI: 49