Hi there! This is my first post, as I am just starting the journey towards weight loss surgery. I have done the research into my specific Cigna healthcare policy and they do cover weight loss surgery with some stipulations. The BMI requirement of 40 I meet, and the program I'm interested in meets the "thourough multidisciplinary evaluation" criteria.  The one criteria I'm concerned about is the 3 months of medically supervised weight management program. I have done so many diets and exercise programs I can barely count them anymore, but they were always supervised by a trainer at the gym or I kept track of calories with an online program - never a physician or registered dietitician. I have no problems going through 3 months of a program like this, but my BMI is right around the 40 limit (5'6" and 250lbs).  If I lose more than two pounds on this medically supervised program I'll fall under the 40 BMI requirement and be ineligible.  My question is, for Cigna's 3 month weight management program do you actually have to lose weight or just show that you've participated?  I really need this surgery or I fear I'll forever be in the cycle of losing 20-30lbs and gaining 40 over and over again for the rest of my life. Does anyone have knowledge or experience with this same situation that could offer advice?

Thanks!

- Lucy

I have no personal experience with Cigna, so I can't help there.  But ...

Aetna has the same requirement.  I did the 3-month multidisciplinary program.  It is imperative that you go for no less than 90 days - 89 days and you will be screwed.  I did something like 105 days just to make sure. 

Regarding losing weight and going under BMI, talk to your surgeon's office.  My surgeon's office submitted final approval to insurance based on my consultation weight - not the weight after I did the 3-month program.  So, even though I lost 40 pounds on the program and my BMI was 39.8 at the time of surgery, I was approved because the weight I was submitted on was 272. 

3 months is a long time to "fake" a program - meaning, following the plan, meeting with dieticians/doctors/nurses/trainers, and not lose weight.  Aetna just implemented a requirement that the patient must not gain weight during the program.  Apparently, you don't have to lose weight, you just can't gain weight. 

So, long story short (too late), call you surgeon's office and ask the insurance coordinator.

I have Cigna and had to go through the 3 months of supervised weight programs.  I had to see a NUT for three months but didn't have to loss weight.  I started seeing her back on July 12 and my last appt. was Oct 3rd.  I am now waiting for approval.  Good luck to you.

I can't tell you anything about it, but i am just writing to share that we have a very similar situation. I am 5'6" and about 250 lbs now. I have gained 20 pounds in the last 3 months but was on 230 for a couple of years. I have Cigna as well, and they told me I also have to be on a 3 months supervised diet. I have not seen a doctor yet but I was concerned about the same thing. Hope we can find some answers to this because I have been reading so much about it and how people who have Cigna had such a hard time being approved and how they had to be on supervised diet for 12 months or so that I am feeling a little scared but I will try anyway. I still have to go to an orientation and see a doctor but I am going to stay positive.

Hi there - I'm a little further into the process now and can tell you what I've learned so far.  Cigna's requirement is the 3 month supervised diet.  You have to have four doctor's appointments, each at least 30 days apart. You don't have to lose weight while on it though - which is good if your BMI is close to 40 already. My best advice would be to first make sure that your individual Cigna plan covers the surgery.  Then take a look at Cigna's specific requirements for coverage, found on their site here: https://cignaforhcp.cigna.com/public/content/pdf/coveragePolicies/medical/mm_0051_coveragepositioncriteria_bariatric_surgery.pdf

If you meet these specific requirements, then they will approve you.  My surgery program takes care of the dietician, physician, psychologist and surgeon recommendations/clearance, so I'm having my PCP take care of the three month requirement and send a letter recommending that I have the surgery. Definetely the first step is go to a seminar at your surgery center. Chances are they have a pretty robust program like that also. If you go through their program and make sure you do the necessary extra steps that Cigna details out, you should have no problem! I haven't gotten approval yet, but I will submit after February 7th (my final weigh in of the 3 months).  After that I'll let you know how it goes!

I do have coverage for the surgery and they told me I need a 3 months supervised diet which was fine with me but reading others experience got me worried because some had cigna and they were requiring over 6 months of supervised diet. I already did my orientation online and sent the surgeon my medical history package and I am waiting it to be reviewed by the surgeon so they can call me for an app. The only problem is that I do not have a PCP( I am not from US, didn't have insurance before until 2 years ago and I have been to 2 PCP once but didn't like them). Not sure if just a letter form the surgeon to the insurance would be enough or if I could use my obgyn.  Hopefully all goes well with you and you get your approval letter soon.

I believe that Cigna switched their requirement from 6 months to 3 months in May of last year (or sometime close to May).  So that is probably why you're seeing all the 6 month info - its a relatively new change.  I also didn't have a PCP before this started.  I asked some coworkers and found one that was nice and set up the monthly appointments with her. She was also very understanding of my need to do the weight management program without losing any serious weight because of the BMI criteria. I don't know if your obgyn would work or not, but you could call Cigna and ask. My surgery program does require a letter from my PCP (its actually a form they have to fill out) recommending me for surgery and sending copies of any recent labs or tests.  I just keep asking and asking questions of everyone I interact with so that I don't miss something. I'd rather be the squeaky wheel now than get disapproved later!  Fingers crossed that works out!

If you fall below the 40 BMI, then the persons processing your approval could decide that you are not eligible.  There is no guarantee either way.  I was careful not to go below 40 BMI on my pre-surgery diet.

I have cigna...also been through 500 million diets.

I did have to got through three month consultation with a NUT. I was on the border like you. 

In this 3 month consultation period you learn a variety of techniques and issues regarding the surgery. For example, taking 30 minutes to eat (not 10 minutes for food and 20 minutes for fun/doing the dishes) concentrating on hunger and fullness, smaller sized plates, spoons and etc, learning to eat and take medications wihtout a beverage, and chewing the food to 'applesauce consistency."

Learning and practicing these techniques over the 3 month period permitted me to make these a habit and to prepare my home for my new way of eating (e.g. out with the gigantic plates/bowls, in with really small spoons (for feeding infants) and dip bowls to become my regular bowl).

I would have been overwhelmed if I had to do/learn this all at once. As a matter of fact, this time is the second time I have considered WLS. The first time I considered it...it required too much change, too fast, with minimial guidance. With the group I am with now, they seem to warn you that a change/new technique/test is needed at one appointment..tell you to actually do it at the second appointment...and see that you have followed up on the third appointment. I like it.  If you are like me and need some time to "wrap your head around things" and how they are going to be and impact your life....a warning that you have to do/learn/accomplish something is good. It allows someone like me to contemplate it, wonder how I am going to do it, research it, and give it a "few trial runs" BEFORE I have to do it with consistent perfection.

It is nice.

So now, at the second time around, I am not nervous or scared. I have executed all the techiques/ways of eating wiht success for two months beforehand. I have already got the supplements all purchased in the cupboard.

I feel confident, sure of myself and sure of the course.

And the three months have made all the difference.