Does Cigna Cover Bariatric Surgery?

Bariatric surgery, often called weight loss surgery, is changing lives for individuals who have struggled to lose weight by other means and are seeing their health decline.

As one of the largest health insurers nationwide, it’s good to know that Cigna covers most forms of bariatric surgery. However, there’s much more to understand about your Cigna bariatric coverage before beginning your journey to better health through bariatric surgery.

Why More Individuals Are Turning to Bariatric Surgery

Over time, obesity can lead to many health problems that affect almost every aspect of an individual’s life. Bariatric surgery alters the digestive system to help individuals lose weight.

Procedures such as gastric sleeve, gastric bypass, or duodenal switch (DS) all offer a similar function of restricting the size of the usable stomach. Malabsorptive procedures like the bypass and DS also employ malabsorption to enhance weight loss, often improving or eliminating many other health issues.

Cigna Bariatric Surgery Eligibility Requirements

While Cigna does cover the bariatric surgeries listed above and band fills and bariatric revisions, they don’t provide this coverage for everyone. Cigna has a set of eligibility requirements for bariatric surgery coverage.

Cigna eligibility requirements may include:

• Eighteen years of age or older and have reached anticipated skeletal growth
• A body mass index (BMI) of 40 or higher
• A BMI of 35 or higher and additional qualifying health conditions, such as diabetes, heart disease, obstructive sleep apnea, and more, but this may vary between plans.
• Evidence of participation in an unsuccessful medically supervised weight-loss program, including monthly weight, exercise, and nutrition documentation.
• A referral for surgery from your primary care physician.
• A psychological evaluation indicates you are ready for the life-long lifestyle changes necessary for long-term surgery success.
• Revision eligibility applies if you fail to lose enough weight (for example, losing less than 50 percent of your excess body weight following the initial surgery). Documentation of follow-up and a GI workup will be required.

Understanding these requirements early in the decision-making process can speed up the time frame for eligibility and provide more realistic expectations.

Out-of-Pocket Cost Considerations with Cigna

The cost you will pay out of pocket for bariatric surgery with Cigna is much the same as for other covered surgeries. One way you can reduce your out-of-pocket costs is by choosing an in-network provider. Cigna has a network of physicians and surgical centers that are preferred providers. Providers outside this network will incur additional costs to the insurance company and you.

Other policy terms that will affect your out-of-pocket costs include:

Deductibles: Your individual or family deductible varies by plan and applies annually. You can find your annual deductibles in your policy’s coverage summary or by contacting Cigna. You may have met none or all of your annual deductible at the time of your surgery. The remainder, if any, will be paid by you directly to the provider.

Co-Insurance: After your family or individual deductible has been met, there are co-insurance amounts for your physician, facility, labs, and more. This is expressed in your Cigna insurance policy as a percentage. Cigna will pay a share, and you will be responsible for the rest.

Understanding how your Cigna policy works in advance can prevent financial surprises and give you time to explore payment plans or financing options if needed.

Still Unsure About Your Procedure Eligibility, Coverage, or Costs with Cigna?

The journey to better health doesn’t happen overnight, but taking the first steps can get you closer to the finish line. If you are still unsure about what your Cigna policy covers, the steps to ensure eligibility, or your costs, establishing a team is the best way to remove that uncertainty.

Your primary care physician, bariatric surgeon, and Cigna customer support are all a part of your success team. Ask questions and make sure you understand each step of the way from the very beginning.

When You Get a Cigna Denial of Coverage for Bariatric Surgery

A denial of coverage can be disheartening. However, if you’ve diligently pursued eligibility and are a good candidate for bariatric surgery, there’s a good chance the denial can easily be reversed.

Follow these steps to bounce back from a Cigna bariatric surgery coverage denial.

1. Contact Cigna customer service. You must first find out the reason for the denial. It could be something simple that can be resolved with a phone call.
2. Communicate with your bariatric practice. Years of experience in communication with insurance companies make your bariatric practice a great ally.
3. Correct and resubmit documentation if it was a clerical error or omission.
4. File an appeal. When you’ve exhausted all other efforts, file an official appeal with Cigna. Errors and miscommunication sometimes occur. That’s why an appeal process exists.

Whatever the obstacle, your bariatric surgery team can help you to find a solution. Your journey to wellness awaits!