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Cigna Insurance Requirements For Bariatric Surgery: A Comprehensive Guide
Bariatric surgery is a weight loss solution that has gained popularity over the years due to its effectiveness in helping people lose weight and maintain a healthy lifestyle. However, this type of surgery can be expensive and may not be covered by health insurance. For those who have Cigna insurance, it is important to understand the requirements for bariatric surgery coverage. In this article, we will discuss the Cigna insurance requirements for bariatric surgery in detail.
What is Bariatric Surgery?
Bariatric surgery is a surgical procedure that helps people who are obese lose weight. It is considered a last resort for those who have tried other weight loss methods, such as diet and exercise, but have not been successful. Bariatric surgery works by reducing the size of the stomach or bypassing a portion of the small intestine. This results in a reduced appetite and a feeling of fullness after eating a smaller meal. Bariatric surgery can improve many health conditions associated with obesity, such as diabetes, hypertension, and sleep apnea.
What is Cigna Insurance?
Cigna is a global health service company that offers a variety of health insurance plans for individuals and families. They offer coverage for medical, dental, vision, and behavioral health services. Cigna has a large network of healthcare providers and facilities, making it easy for its members to access the care they need.
Cigna Insurance Requirements For Bariatric Surgery
Cigna insurance may cover bariatric surgery if certain requirements are met. These requirements are in place to ensure that the surgery is medically necessary and that the patient is a good candidate for the procedure. Here are the requirements for Cigna insurance coverage of bariatric surgery:
1. Body Mass Index (BMI) Criteria
Cigna insurance requires that patients have a BMI of at least 40, or a BMI of 35-39.9 with at least one obesity-related health condition. Obesity-related health conditions include diabetes, hypertension, sleep apnea, and others. Patients must have documentation of their BMI and obesity-related health conditions from their healthcare provider.
2. Previous Weight Loss Attempts
Patients must have tried and failed to lose weight through diet and exercise before being considered for bariatric surgery. This must be documented by a healthcare provider.
3. Medical Necessity
Bariatric surgery must be deemed medically necessary by a healthcare provider. This means that the patient has a severe obesity-related health condition that cannot be treated with other medical interventions.
4. Psychological Evaluation
Patients must undergo a psychological evaluation to determine if they are mentally and emotionally prepared for the surgery and the lifestyle changes that come with it. This evaluation must be conducted by a licensed mental health professional.
5. Nutritional Counseling
Patients must receive nutritional counseling before and after the surgery to ensure that they are eating a healthy and balanced diet. This counseling must be provided by a registered dietitian.
6. Bariatric Surgery Consultation
Patients must have a consultation with a bariatric surgeon to discuss the risks and benefits of the surgery and to determine if they are a good candidate for the procedure.
7. Pre-authorization
Before the surgery can take place, Cigna insurance requires pre-authorization. This means that the healthcare provider must obtain approval from Cigna before the procedure can be performed. This is to ensure that the surgery is medically necessary and that the patient meets all of the insurance requirements.
Coverage Limits and Costs
Cigna insurance may cover the cost of bariatric surgery, but there may be limits to the coverage. Patients should check their insurance policy to see what is covered and what is not covered. Some policies may have a lifetime limit on bariatric surgery coverage, while others may require a copayment or deductible. Patients who do not meet the insurance requirements for bariatric surgery may have to pay for the procedure out of pocket.
Conclusion
Bariatric surgery can be a life-changing procedure for those who struggle with obesity and related health conditions. However, it is important to understand the insurance requirements for coverage of the procedure. Cigna insurance requires that patients meet certain criteria, including BMI, previous weight loss attempts, medical necessity, psychological evaluation, nutritional counseling, and pre-authorization. Patients should also check their insurance policy to see what is covered and what is not covered. By understanding the insurance requirements for bariatric surgery, patients can make an informed decision about their weight loss journey.
