![]() ![]() Requirements for Weight Loss Surgery. Most policies with Cigna cover weight loss surgery. However, some benefit plans do specifically exclude bariatric surgery. Contact Cigna directly to find out if your plan includes weight loss surgery coverage. Cigna recently merged with Great West Healthcare. The following applies to Great West Healthcare as well. Cigna Pre- approval Requirements. Unless weight loss surgery is specifically excluded from your policy, surgery is covered if the following criteria are met: The individual is at least 1. AND has evidence of EITHER of the following: A Body Mass Index (BMI) of 4. A Body Mass Index between 3. Type 2 Diabetes. High Cholesterol. Heart Disease. Pulmonary Hypertension. Everything you need to determine whether Cigna weight loss surgery benefits are included in your plan. WebMD explains the cost of weight loss surgery, what is covered by insurance, and how to convince your insurance company to pay for weight loss surgery. It's common to find health insurance companies that will not pay for weight-loss surgery, yet these same insurers are paying for years of treating the conditions. Obstructive Sleep Apnea. You must also show that other methods of medically supervised weight loss programs have failed. ![]() The medically supervised weight management program must include monthly documentation of ALL of the following: Advertisementweightnutritional programexercise program. An evaluation from a bariatric surgeon and your primary care physician with a resulting recommendation for surgery is necessary. A mental health evaluation is required as well as a nutritional evaluation from a physician or registered dietitian. Types of Weight Loss Surgeries Covered By Cigna. If you’re unsure which procedure is right for you, take our test. ![]() Many insurance plans, including Medicare and most Medicaid plans, cover bariatric surgery. Coverage varies, so we help you find out what your plan provides. UHS can help you lose weight. Through bariatric surgery, weight loss patients typically lose weight more quickly in than with diet alone. ![]() Are lap band fills covered? Yes, Cigna covers lap band fills as necessary. Procedures excluded from coverage. Gastric bypass combined with a gastric band. Biliopancreatic diversion without a duodenal switch. Fobi- Pouch. Loop gastric bypass. Intra- gastric balloons. NOTES – natural orifice surgery (Stomaphyx, etc.)Is a second weight loss surgery covered if lap band doesn’t work? ![]() Yes, it is covered if the first procedure was unsuccessful. An unsuccessful procedure is defined as a failure to lose 5. Does Insurance Company Require Center of Excellence? Cigna does not appear to require a COE designation at this time. Do I have to use an In- Network Bariatric Surgeon? While your out- of- pocket expenses may be higher, you do not need to choose an in- network provider. Individual policies may vary. Cigna’s Contact Info to Inquire About Surgery. For questions on Benefits with Cigna call: 1. CIGNA2. 4 (1. 8. 00. Cigna’s Weight Loss Surgery Full Coverage Statement. ![]() SSM Health Weight Management Services offers breakthrough surgical and non-surgical options that can be tailored to fit your weight-loss goals. Comprehensive list of insurance companies and their requirements to approve coverage for lap bands, gastric bypass, gastric sleeve and other weight loss. These weight loss surgery insurance secrets can save you money, time and even get coverage added to your insurance plan. WebMD explains how weight loss surgery, such as gastric bypass or gastric banding, can help people manage type 2 diabetes. Cigna’s full bariatric surgery coverage statement can be found here. Medicaid's Requirement for Weight Loss Surgery. Medicaid’s Requirement for Weight Loss Surgery. Medicaid’s requirements for weight loss surgery coverage are a little different as compared to other insurance plans, typically because Medicaid is unique in who they cover and how they cover their patients. You need to meet a number of specific requirements in order to qualify for weight loss surgery through Medicaid, and you also need to be free from any medical issues that would prevent you from having surgery. If you pass these two tests, then Medicaid will generally pay for your weight loss surgery. Criteria for Surgery Cost Coverage Through Medicaid. In order for Medicaid to completely cover the cost of your surgery as well as the associated visits with your surgeon, you are going to need to meet all of the following criteria. You will need to be over the age of 1. Your Body Mass Index (BMI) must exceed 3. If you are below the age of 2. Body Mass Index (BMI) exceeding 4. You must have a printed letter from your primary care physician recommending the medical necessity of weight loss surgery. You need to pass a mental health exam showing that you are capable of adopting the necessary lifestyle changes for weight loss. You must be able to provide documentation showing that you have tried to manage your weight and comorbidities using standard treatment, but that those attempts were unsuccessful. You must complete a medically supervised program for weight loss spanning 6 months, and you need to show documentation that this weight loss program was attempted within the past 1. Some people will not qualify for weight loss surgery through Medicaid. If you have any of the following conditions or issues, you will not qualify. Long- term use of steroids,Malignant cancer,Chronic pancreatitis, inflammatory bowel disease or pregnancy,Non- compliance with medical treatments,Psychological treatment that could interfere with your new diet and lifestyle. Procedures Medicaid Will Cover for Weight Loss. Assuming that you meet all of the criteria mentioned above, Medicaid will pay the coverage for the following weight loss surgery procedures: Gastric bypass procedures,Gastric sleeve surgeries,Lap gastric bands (Lap Band, Realize Band)Bottom Line and Other Considerations. One of the requirements for Medicaid to pay for your surgery coverage is that you need to have your weight loss surgery done through a Center for Excellence. Bariatric Center for Excellence accreditation is designed to indicate which bariatric surgery centers have achieved a level of excellence when it comes to administering bariatric surgery. Medicaid requires that you visit one of these specific centers to guarantee that you get the best possible treatment. If you have questions about your Medicaid coverage and whether or not your coverage will pay for weight loss surgery, the best thing to do is to contact the people at Medicaid directly to discuss your coverage. There are many types of surgery that you can undergo for weight loss, but Medicaid only covers the most common ones. If you’re looking to have a different type of weight loss surgery aside from gastric bypass, lap gastric banding or gastric sleeve surgery, then you will need to look for a different type of insurance coverage or you will need to pay out- of- pocket for the procedure.
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