Cigna, as a global health service company, offers a wide range of health insurance services, which makes it a top choice for many seeking medical coverage.
If you’re a Cigna policyholder or are thinking about getting Cigna for your health insurance, you might be wondering what kind of coverage you can expect for this procedure. One of the most common questions that comes to mind is, “Does Cigna cover Bariatric Surgery?”
No worries, this detailed guide has got you covered! It simplifies Cigna’s coverage for bariatric surgery, providing the clarity you need to make informed healthcare choices.
Bariatric surgery, also known as metabolic surgery, is a weight loss procedure for those struggling with obesity. It helps when diet and exercise alone are ineffective or when serious health issues arise due to weight. By reducing food intake, this surgery aids in weight loss.
These surgeries work by either reducing the size of the stomach, allowing the person to feel full with less food, or by changing the small intestine – the part of the body that absorbs calories and nutrients from foods.
The most common types of bariatric surgery include gastric bypass, sleeve gastrectomy, adjustable gastric band, and biliopancreatic diversion with duodenal switch.
Each procedure has its own benefits and risks, and a healthcare professional can help determine which one is most suitable based on the individual’s overall health condition, BMI, and lifestyle habits.
Bariatric surgery benefits
According to the American Society for Metabolic and Bariatric Surgery, approximately 90% of individuals who undergo bariatric surgery successfully achieve a 50% reduction in excess body weight and keep this extra weight off long-term.
Here are some of the potential benefits of bariatric surgery. These include:
- Significant and sustained weight loss
- Improvement or resolution of obesity-related health conditions
- Increased mobility and ability to engage in physical activities
- Improved overall quality of life
- Potential reduction in healthcare costs for treating obesity-related conditions
- Enhanced quality of life and self-esteem
- Reduced risk of premature death
Does Cigna cover Bariatric surgery?
Yes, the good news is that Cigna does cover bariatric surgery, but the coverage depends on the specific health insurance plan you have and the medical necessity of the procedure.
Cigna’s Bariatric Surgery Coverage Policy states that procedures like gastric bypass, sleeve gastrectomy, and adjustable gastric bands are covered when deemed medically necessary. However, all requests for bariatric surgery coverage must go through a prior authorization process.
It’s important to note that while Cigna covers bariatric surgery, the amount of coverage will vary based on your specific insurance plan. Cigna offers a variety of plans with different deductibles, copayments, and out-of-pocket maximums. Therefore, even if the procedure is covered, the out-of-pocket costs can vary significantly.
Requirements for Cigna Bariatric Surgery
To qualify for bariatric surgery coverage under Cigna, there are certain requirements that must be met. These include, but are not limited to:
- The patient must be at least 18 years old.
- The patient must have a Body Mass Index (BMI) of 40 or higher, or a BMI of 35 or higher with at least one obesity-related comorbidity, like diabetes, hypertension, or sleep apnea.
- Previous unsuccessful attempts at non-surgical weight loss methods, such as diet and exercise, behavioral therapy, or pharmacotherapy, are required.
- The patient must be free from drug or alcohol abuse for at least one year prior to surgery.
- The patient must complete a psychological evaluation to ensure they are prepared for the lifestyle changes required after surgery.
- The patient’s primary care physician or specialist must provide a letter of medical necessity.
As we mentioned, while Cigna’s coverage for bariatric surgery can offer substantial financial support, it’s important to take into account potential expenses that may need to be paid out-of-pocket, such as deductibles and co-pays.
Tips for getting coverage with Cigna
If you’re considering bariatric surgery and have Cigna insurance, here are a few tips to increase your chances of getting coverage:
- Educate yourself: Familiarize yourself with your specific Cigna plan, which includes coverage details and any requirements for bariatric surgery.
- Seek guidance: Consult with your doctor who specializes in bariatric surgery. They can provide the necessary documentation and guide you through the process.
- Follow the guidelines: Adhere to all the requirements set forth by Cigna, like completing pre-surgery evaluations, attending counseling sessions, and meeting any weight loss goals.
- Keep detailed records: Maintain a record of all your medical visits, tests, and consultations related to bariatric surgery. This documentation will be essential when submitting claims to Cigna.
How long does Cigna take to approve Bariatric surgery?
The time it takes for Cigna to approve bariatric surgery can vary, but it usually ranges from 2 to 4 weeks.
This period is known as the “pre-certification” process, during which Cigna reviews your medical documents, the surgeon’s recommendation, and other relevant information to figure out if the surgery is medically necessary.
However, approval time can be changed by factors such as the completeness of the submitted documents, the complexity of the patient’s medical history, and the demands on Cigna’s review team.
Follow the application process carefully to avoid delays. Keep in mind that approval from Cigna doesn’t guarantee full-cost coverage, so be familiar with your plan’s details.
Cigna does cover bariatric surgery, but the extent of coverage may vary depending on your specific plan. It’s important to thoroughly review your policy, consult with healthcare professionals, and meet all necessary requirements to increase your chances of receiving coverage for this life-changing procedure.
Always consult with your insurance provider and healthcare professionals to obtain accurate and personalized information regarding Cigna’s coverage of bariatric surgery.
What is the most affordable Bariatric surgery?
The most affordable bariatric surgery is generally Gastric Sleeve Surgery, also known as Sleeve Gastrectomy. This is a laparoscopic surgery, which means it is less invasive and has a shorter hospital stay compared to other types of bariatric surgeries. Keep in mind, that the total cost can vary. Always consult with your healthcare provider and insurance company to understand the full cost of the procedure.
Does Cigna cover sleeve gastrectomy?
Yes, Cigna does cover Sleeve Gastrectomy, as per their Bariatric Surgery Coverage Policy. However, the coverage and out-of-pocket expenses for it will vary based on the details of your Cigna health insurance plan. Additionally, the surgery needs to be considered medically necessary.
Does Cigna cover online therapy?
Yes, Cigna does cover online therapy, also known as teletherapy or telehealth mental health services. This is as per their Telehealth Connection Policy. However, the coverage details may vary based on your specific Cigna plan and the state where you’re receiving the services. It’s always advisable to check with Cigna directly for the most accurate information about your online therapy coverage.
Does Cigna cover breast pumps?
Yes, Cigna does cover breast pumps as per the Affordable Care Act (ACA). The health insurance plans cover breastfeeding support and supplies. However, the type of breast pump (manual or electric), the duration of the coverage, and whether you can purchase or rent one may vary based on your specific Cigna health insurance plan. Cigna encourages you to call the number on your ID card or log in to your online account to get detailed information on your coverage.