Tool: Check Your Weight Loss Surgery Insurance – Cigna

In order to be approved by Cigna Health Insurance for bariatric surgery in the United States, you must meet the following criteria:

1. The individual is at least 18 years of age OR has reached full expected skeletal growth AND has evidence of EITHER of the following:
2. Diagnosis of Morbid obesity, defined as:
• A Body Mass Index (BMI) greater than 40
• A BMI (Body Mass Index) 35 – 39.9 with at least one clinically significant obesity – related comorbidity, including but not limited to the following:
• Mechanical arthropathy in a weight – bearing joint
• Type 2 diabetes mellitus
• Poorly controlled hypertension (systolic blood pressure at least 140 mm Hg or diastolic blood pressure 90 mm Hg or greater, despite optimal medical management)
• Hyperlipidemia
• Coronary artery disease
• Lower extremity lymphatic or venous obstruction
• Obstructive sleep apnea
• Pulmonary hypertension

Use this BMI Calculator to check your body mass index:

3. Medical management including evidence of active participation within the last 12 months in a weight – management program that is supervised either by a physician or a registered dietician for a minimum of three consecutive months ((i.e., at least 89 days). The weight – management program must include monthly documentation of ALL of the following components:
• Weight
• Current dietary program
• Physical activity (e.g., exercise program)

Medical Management & Other Weight Loss Programs

Programs such as Weight Watchers® , Jenny Craig® and Optifast® are acceptable alternatives if done in conjunction with the supervision of a physician or registered dietician and detailed documentation of participation is available for review.

However, physician-supervised programs consisting exclusively of pharmacological management are not sufficient to meet this requirement.

4. A thorough multidisciplinary evaluation within the previous six months which includes ALL of the following:
• an evaluation by a bariatric surgeon recommending surgical treatment, including a description of the proposed procedure(s) and all of the associated Current Procedural Terminology (CPT) codes
• A separate medical evaluation from a physician other than the requesting surgeon that includes a recommendation for bariatric surgery
• Unequivocal clearance for bariatric surgery by a mental health provider
• A nutritional evaluation by a physician or registered dietician

Revision Requirements

Reoperation and Repeat Bariatric Surgery – Cigna covers surgical reversal (i.e., takedown) of bariatric surgery as medically necessary when the individual develops complications from the original surgery such as stricture or obstruction. Cigna covers revision of a previous bariatric surgical procedure or conversion to another medically necessary procedure due to inadequate weight loss as medically necessary when ALL of the following are met:

1. Coverage for bariatric surgery is available under the individual’s current health benefit plan
2. There is evidence of full compliance with the previously prescribed postoperative dietary and exercise program
3. Due to a technical failure of the original bariatric surgical procedure (e.g., pouch dilatation) documented on either upper gastrointestinal (UGI) series or esophagogastroduodenoscopy (EGD), the individual has failed to achieve adequate weight loss, which is defined as failure to lose at least 50% of excess body weight or failure to achieve body weight to within 30% of ideal body weight at least two years following the original surgery
4. The requested procedure is a regularly covered bariatric surgery

Contact Cigna Health Insurance to Ask About Bariatric Surgery

• By Phone: 1-800-285-4812
• Contact Cigna Health Insurance
• Full Bariatric Surgery Medical Policy for Cigna Health Insurance