CIGNA in NYC questions
http://www.cigna.com/customer_care/healthcare_professional/c overage_positions/medical/mm_0051_coveragepositioncriteria_b ariatric_surgery.pdf
They do require a 6 month "Program"
I did the atkins diet and had my Primary doctor signoff on my progress. I saw him once a month for an office visit that included my wieght.
I created a spreadsheet that had my wieght, What excercise I did.
Here's an excerpt from the policy:
Coverage Policy
Bariatric surgery is specifically excluded under many benefit plans and may be governed by state and/or federal mandates. Please refer to the applicable benefit plan document to determine benefit availability and the terms and conditions of coverage. Unless excluded from the benefit plan, this service is covered when the following medical necessity criteria are met. CIGNA covers bariatric surgery using a covered procedure outlined below as medically necessary when ALL of the following criteria are met: �� ��
Page 1 of 40 Coverage Policy Number: 0051
minimum of six months without significant gaps. The weight-management program must include monthly documentation of
Programs such as Weigh****chers®, Jenny Craig® and Optifast® are acceptable alternatives if done in conjunction with the supervision of a physician or registered dietician 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. However, physician-supervised programs consisting exclusively of pharmacological management are not sufficient to meet this requirement.
• A thorough multidisciplinary evaluation within the previous 12 months whi*****ludes the following:
��
weight��
current dietary program��
physical activity (e.g., exercise program)��
an evaluation by a bariatric surgeon recommending surgical treatment, including a description of the proposed procedure(s) and all of the associated current CPT codes��
a separate medical evaluation from a physician other than the surgeon recommending surgery, that includes a medical clearance for bariatric surgery��
unequivocal clearance for bariatric surgery by a mental health provider��
a nutritional evaluation by a physician or registered dietician•
• Failure of medical management including evidence of active participation within the last two years in a weight-management program that is supervised either by a physician or a registered dietician for a
Highest Weight: 380 Consult Weight: 357 Surgery Weight: 309
Goal Weight: 220 (9/29/10) Revised Goal Range 215-220 Current Weight: 224
Plastics: Circumferential Lower Body Lift - 11/18/2011
Gynecomastia - 6/14/2012
I love it. It's working well. No regrets. The weight is comming off rapidly.
I wouldn't choose any other surgery. I'll send you a friend request so you can look at my progress on my Blog.
Highest Weight: 380 Consult Weight: 357 Surgery Weight: 309
Goal Weight: 220 (9/29/10) Revised Goal Range 215-220 Current Weight: 224
Plastics: Circumferential Lower Body Lift - 11/18/2011
Gynecomastia - 6/14/2012
