Tool: Check Your Weight Loss Surgery Insurance - Cigna
Your Cigna Health Insurance weight loss surgery insurance coverage depends on several factors, all of which are reviewed below.
First, use our free insurance check tool to quickly double check your plan:
Read and click below for additional weight loss surgery insurance details.
TABLE OF CONTENTS
- Coverage Requirements
- Coverage by Plan Type
- Covered Weight Loss Procedures
- Appealing a Denial
- Find a Top Weight Loss Surgeon
35+ Body Mass Index (BMI)
Documentation of failed diet attempts
READ THIS FIRST
Even if your insurance company covers bariatric surgery in some plans, that does not mean that your specific plan covers it. The obesity surgery approval requirements in this section assume that weight loss surgery is covered by your specific policy.
To confirm whether your specific policiy covers bariatric surgery, click here to contact a surgeon and ask for a free insurance check.
Disclaimer: The information contained on this page may not include all components of your insurance company’s medical policy and/or may not be up to date. Contact your insurance company to confirm all benefits.
In order to be approved by Cigna Health Insurance for bariatric surgery in the United States, you must meet the following criteria:
- The individual is at least 18 years of age OR has reached full expected skeletal growth AND has evidence of EITHER of the following:
- 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)
- Coronary artery disease
- Lower extremity lymphatic or venous obstruction
- Obstructive sleep apnea
- Pulmonary hypertension
Use this BMI Calculator to check your body mass index:
- 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.
- 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
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:
- Coverage for bariatric surgery is available under the individual’s current health benefit plan
- There is evidence of full compliance with the previously prescribed postoperative dietary and exercise program
- 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
- The requested procedure is a regularly covered bariatric surgery
If Your Policy Does NOT Cover It: Seek Partial Coverage
You may be able to get part of the costs paid for by insurance even if weight loss surgery isn’t covered. It’s all about how your doctor and hospital submit your claims to your insurance company.
For example, there are many non-bariatric surgery reasons for your doctor to recommend:
- Cardiology exam
- Lab work
- Medically supervised diet program
- Psychological exam
- Sleep study
These are ordered for many reasons other than bariatric surgery and may be covered as a result. If your doctor submits one of these claims using a weight loss surgery CPT code (Current Procedural Terminology Code), your insurance is unlikely to cover it. But if your doctor uses a general CPT code, it probably will be covered.
While this may sound “sneaky”, it is an ethical practice. After all, these tests will be beneficial regardless of whether you move forward with surgery.
Contact Cigna Health Insurance to Ask About Bariatric Surgery
- By Phone: 1-800-285-4812
- Full Bariatric Surgery Medical Policy for Cigna Health Insurance
Coverage by Plan Type
Coverage Through Your Employer
Individual & Family Plans
Before getting into the types of insurance plans, you can cut to the chase by contacting a local bariatric surgeon’s office. Most surgeons will contact your insurance company for free to confirm whether or not you’re covered.
Cigna Health Insurance does cover weight loss surgery, but your specific policy must include it in order for you get it covered.
Following are a list of Cigna Health Insurance plan types and whether they cover bariatric surgery:
Insurance Weight Loss Surgery for Health Plans Through Your Work
If you work for a company that has 50 or more full time employees, it is completely up to your employer to decide whether or not to cover bariatric surgery under your health plan.
To find out whether weight loss surgery is covered by your employer’s plan, you have a few options:
- Your local surgeon will usually be willing check your insurance for free. Click here to find a surgeon near you, then call or email them to request a free insurance review.
- Ask your Human Resources department
- Contact your insurance company directly using the phone number on your insurance ID card
Insurance Weight Loss Surgery for Individual/Family Plans
The Affordable Care Act (Obamacare) requires all individual and small group plans (less than 50 full time employees) to include weight loss surgery coverage as long as it is considered an “Essential Health Benefit” in your state.
The following states DO currently consider bariatric surgery an Essential Health Benefit (bariatric surgery is covered by all individual, family and small group plans in these states):
Your State Not on the List?
If your state is NOT on the list, then weight loss surgery is probably NOT covered under your plan.
First, contact your local surgeon to be sure. For no charge, their office will contact your insurance company on your behalf to work through the details.
If your surgeon confirms that your policy does not include obesity surgery, you still have several options for making surgery more affordable. See these pages for more information:
- Weight Loss Surgery Insurance Secrets: Revised List (good tips even if your policy does not include bariatric surgery)
- Financing bariatric surgery (all of your options)
- New Hampshire
- New Jersey
- New Mexico
- New York
- North Carolina
- North Dakota
- Rhode Island
- South Dakota
- West Virginia
Regardless of whether your state is on the list, contact a qualified surgeon to request a free insurance check to verify your coverage.
To review your insurance company’s obesity surgery coverage requirements, click here to jump back up the page.
Insurance Weight Loss Surgery for Medicare Plans
All Medicare plans are required to cover the following weight loss surgery procedures:
- Gastric sleeve surgery
- Gastric bypass surgery
- Gastric banding (lap band surgery) (LASGB)
- Duodenal switch surgery (DS)
- Biliopancreatic diversion surgery (BPD)
However, special Medicare-specific criteria apply. Click here to learn more about Medicare bariatric surgery coverage.
Covered Weight Loss Procedures
Vertical Banded Gastroplasty
Please see below for the procedures Cigna Health Insurance covers, might cover under certain circumstances, and those that are not covered under any circumstances:
Procedures That ARE Covered
Procedures That MIGHT BE Covered
The following procedures MIGHT BE covered by Cigna Health Insurance:
Note About Cigna Bariatric Surgery Revision Coverage
Inadequate weight loss due to individual noncompliance with postoperative nutrition and exercise recommendations is not a medically necessary indication for revision or conversion surgery and is not covered by Cigna.
Procedures That Are NOT Covered
The following procedures are NOT covered by Cigna Health Insurance:
- Gastric Balloon
- vBloc Therapy
- Mini Gastric Bypass Surgery
- Roux-en-Y gastric bypass combined with simultaneous gastric banding biliopancreatic diversion (BPD) without duodenal switch (DS)
- Fobi Pouch (limiting proximal gastric pouch)
- gastric electrical stimulation (GES) or gastric pacing
- Gastroplasty (stomach stapling)
- Intestinal bypass (jejunoileal bypass)
- Laparoscopic greater curvature plication
- Loop gastric bypass
- Natural Orifice Transluminal Endoscopic Surgery (NOTES)/endoscopic oral – assisted bariatric surgery procedures, including but not limited to the following:
- Restorative obesity surgery, endoluminal (ROSE)
- Duodenojejunal bypass liner (e.g., Endobarrier™)
- Transoral gastroplasty (e.g., TOGA ®)
- Cigna does not cover ANY bariatric surgical procedure when performed solely for the treatment of type 2 diabetes mellitus because it is considered experimental, investigational or unproven for this indication.
Other Procedures NOT Covered by Cigna During Weight Loss Surgery
Cigna does not cover ANY of the following performed in conjunction with a bariatric surgery because each is considered not medically necessary:
- Cholecystectomy in the absence of signs or symptoms of gallbladder disease
- Liver biopsy in the absence of signs or symptoms of liver disease (e.g., elevated liver enzymes, enlarged liver)
- Herniorrhaphy for an asymptomatic hiatal hernia
- Routine vena cava filter placement for individuals not at high risk for venous thromboembolism (VTE)
Appealing a Denial
General Appeal Instructions
Appeal Details Specific to Aetna
If Cigna Health Insurance denies your weight loss surgery claim and you think it should be covered, consider filing an appeal.
Find A Top Weight Loss Surgeon
Ask for a free insurance check or cost quote
Attend a free seminar or webinar
Schedule a phone or in-person consultation (both often free)
Search the weight loss surgeon directory below to ask a top surgeon about a free insurance check by country and region: