Does Cigna Cover Weight Loss Surgery?
Understanding Cigna's Coverage for Weight Loss Surgery
Yes, Cigna does cover weight loss surgery under certain conditions. Coverage is typically provided for medically necessary procedures such as gastric bypass and sleeve gastrectomy when specific criteria are met. It's essential for patients to understand the requirements and process to ensure they receive the benefits they need for their weight loss journey.
Does Cigna Cover Weight Loss Surgery?
Cigna's coverage for weight loss surgery is contingent on several factors, including medical necessity and specific eligibility criteria. To qualify for coverage, patients generally need to demonstrate that they have a body mass index (BMI) of 40 or higher, or a BMI of 35 or higher with obesity-related health conditions such as diabetes or hypertension.
Before proceeding with surgery, patients are encouraged to consult with their healthcare provider to determine if they meet Cigna's criteria. Additionally, Cigna may require documentation of previous weight loss attempts and participation in a medically supervised weight loss program.
Key Coverage Criteria
- BMI requirements: 40 or higher, or 35 with comorbidities
- Documentation of previous weight loss attempts
- Participation in a medically supervised weight loss program
- Approval from a qualified healthcare provider
Quick Facts
Steps to Ensure Coverage
Step 1
Consult with your primary care physician to discuss your weight loss goals and health history.
Step 2
Get a referral to a bariatric surgeon who is in-network with Cigna.
Step 3
Complete a medically supervised weight loss program as required by Cigna.
Step 4
Submit all necessary documentation to Cigna for pre-approval.
Comparison of Common Weight Loss Surgeries
| Surgery Type | Average Cost | Recovery Time | Weight Loss Potential |
|---|---|---|---|
| Gastric Bypass | $20,000 - $25,000 | 2-4 weeks | 60-80% of excess weight |
| Sleeve Gastrectomy | $15,000 - $20,000 | 1-2 weeks | 50-70% of excess weight |
Pros and Cons of Weight Loss Surgery
Pros
- Significant weight loss potential
- Improvement in obesity-related health conditions
- Enhanced quality of life
Cons
- Surgical risks and complications
- Long-term dietary changes required
- Possible need for follow-up procedures
Frequently Asked Questions
- Q: How do I know if I qualify for Cigna's coverage?
A: You must meet specific BMI criteria and provide documentation of previous weight loss attempts. - Q: What types of weight loss surgeries does Cigna cover?
A: Cigna typically covers gastric bypass, sleeve gastrectomy, and other medically necessary procedures. - Q: Is there a waiting period for coverage?
A: Coverage may depend on the specific plan, so it's best to check with Cigna directly.
Jaden Bohman is a researcher led writer and editor focused on productivity, technology, and evidence based workflows. Jaden blends academic rigor with real world testing to deliver clear, actionable advice readers can trust.
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