Question:
does this mean it pay for wls????

plan provides coverage for medically necessary service.your plan does not provide coverage for the following except as required by law:(1) services that are not medically nessary except specifically outlined preventive.(2)cosmetic surgery unless a person receives an injury while result in bodily damage requring the surgery or it qualifes as reconstrutive surgery following medically nessary surgery it is required to provide correct or restore a normal bodily function...    — SHERRY M. (posted on August 16, 2002)

August 17, 2002
As long as there is no exclution, you have a chance at getting your insurance to pay for WLS. The info that you included did not exclude WLS, but it did say that it won't pay for something that was not medically necessary. So it all depends on if your insurance company considers WLS medically necessary. Every company has its own views on WLS. YOu might want to check on this site to see if others in your state have good things to say about your company. Good luck.
   — Sarah K.

August 17, 2002
That sounds really vague. Call your insurance company and specifically ask them if they will cover weight loss surgery for the <i>morbidly obese</i>. Make sure that you stress that you are MO- weighing more than 100lbs. and having a BMI over 40. Most policies will not pay for surgery or any other weight related programs for the obese, but if there in no exclusion about MO, then you are probably in the good. Call them!!
   — karmiausnic

September 12, 2002
you're in luck b/c I called Cigna today to find out EXACTLY what they require for eligibility for bariatric surgery. Here's the response I got. Hope it helps! "vexxtra" Dear Ms. @#$%$#: Thank you for your inquiry about the medical necessity criteria for gastric bypass surgery. Here are some facts about how the condition is evaluated: The Body Mass Index (BMI) is an objective measurement, which is currently considered the most accurate measurement of excess adipose (fat) tissue. The National Institute of Health defines obesity as a BMI of greater than 27.5kg, and severe or morbid obesity as greater than 40kg. A comorbid condition occurs when another part of the body becomes diseased as a result of the morbid obesity. Examples include: hypertension, gastric reflux, diabetes mellitus, coronary artery disease, pulmonary dysfunction, severe sleep apnea, lower extremity venous and lymphatic obstruction, obesity related pulmonary hypertension, symptomatic osteoarthritis of the knee, hip, or back. Gastric bypass surgery is considered medically necessary and will be covered under the terms of your benefit plan if all of these criteria are met: BMI Greater than 40kg for at least five years, or Between 35-40kg with additional documentation of one or more clinically significant comorbidities that have failed to respond to non-surgical treatment, including appropriate and adequate medication. Previous Weight Loss Attempts In addition to the minimum weight requirements, you must submit documentation supporting previous weight loss attempts. The patient must have actively participated and reasonably complied in at least three professionally supervised weight loss programs for a minimum of twelve weeks in each program. At least one of these programs should have included weigh-ins on a regular basis. Age and Risk The patient must be an acceptable age and risk for surgery. This is determined by the Primary Care Physician (PCP). Comorbidities The medical records should indicate that the PCP has made efforts to treat any comorbidities using standard conservative protocols. It's important you know that the referring physician must receive pre-authorization through CIGNA's Health Services Department by submitting clinical information supporting all of the above medical necessity criteria. Please contact your PCP to discuss possible treatment plans. If the PCP feels that surgery may be necessary and that you meet the above criteria, he or she can contact the Health Services Department to start the pre-authorization process. In addition, please know CIGNA HealthCare does not guarantee or represent that any particular benefits will be paid. Payment is based on the terms of the group plan and the patient must be eligible when receiving treatment. Ms. Q@#$$#, I hope this information is helpful to you. Thank you for visiting our web site. Sincerely, A. Garcia Internet Customer Service Team CIGNA HealthCare www.cigna.com Please do not respond to this e-mail ------------------------------------------------------------------------------ CONFIDENTIALITY NOTICE: If you have received this e-mail in error, please immediately notify the sender by e-mail at the address shown. This e-mail transmission may contain confidential information. This information is intended only for the use of the individual(s) or entity to whom it is intended even if addressed incorrectly. Please delete it from your files if you are not the intended recipient. Thank you for your compliance. Copyright (c) 2002 CIGNA
   — AMY P.