Cost is an important part of planning for any surgery. Due to the nature of bariatric coverage, we do our best to make cost and coverage transparency a part of the process early on. We urge all our weight loss surgery patients to verify their bariatric coverage and familiarize themselves with their Cigna policy language and the criteria set forth specifically for bariatric surgery. Our team is always willing to discuss benefits and coverage with a bariatric surgery candidate and we are here to help guide you. Your Cigna plan will likely require some basic criteria for coverage of weight loss surgery through your insurance plan.
The consideration when reviewing your Florida Cigna plan for obesity treatment is what is covered and any exclusions, or non-covered services, in your policy. A phone call to your Cigna member services team can help you to understand your unique coverage and benefits. Should bariatric surgery be excluded from your plan, you will typically see this noted in the section called “policy exclusions.” If bariatric surgery is listed as a covered procedure in your plan, you will see detailed information on Cigna’s the guidelines for qualification. We always emphasize that coverage does vary, and you should always verify directly with your insurance representative. It is valuable to contact Cigna as well as our office to discuss your eligibility and benefits early in your weight loss surgery process.
Your actual out of pocket expense for bariatric care will vary based on your benefits and a few other factors. Calling Cigna to discuss your coverage and benefits using the phone number on the back of your insurance card is the best place to start. Your insurance representative can explain the breakdown of your policy and any amount outstanding in your deductible or various policy maximums. At your first appointment with MASJax, our Bariatric Coordinator will discuss your benefits and estimates of what you can plan for financially. We will also review your policy guidelines for coverage of weight loss surgery. Pre-approval by your insurance company is a sometimes a necessary but is never a guarantee of coverage.
If your plan has a deductible, co-insurance, or an out-of-pocket maximum, we will discuss those amounts with you and detail how that translates to your planned surgery. If you meet the required guidelines and are ready to move forward with a bariatric procedure, we will make the appropriate pre-op testing and scheduling arrangements. For most plans, these amounts will reset at the end of the calendar year. Any amount paid through your insurance for medical services during the previous year will not be counted toward your maximum should you roll into a new year. With that in mind, if you had several claims earlier in the year, you may have met or be closer to meeting your maximum out of pocket cost. The bariatric surgery process typically involves several pre-operative visits and clearances prior to your surgery being scheduled. If you have a specific timing in mind for your surgery, it is best to start the process well in advance.
We will review your exact Cigna policy criteria to help avoid delay in your pre-approval, but you are responsible for understanding your benefits and coverage. The information below is a general guideline for standard pre-approval of bariatric surgery. Your policy guidelines may differ.
Cigna of Florida covers for several bariatric procedures. These include the gastric sleeve (sleeve gastrectomy) and the gastric bypass. These are the two most performed weight loss surgeries. There are some bariatric procedures that are not covered by Cigna in Florida. Non-covered procedures include the intragastric balloon, Lap-Band for lower BMI patients, and surgeries considered to be experimental.
Coverage may be available for a secondary or revision of a bariatric procedure in some circumstances. You may require documentation in your medical record indicating that failure to lose or maintain weight loss is not due to a lifestyle consideration like poor diet or lack of exercise. For patients interested in having a revision bariatric surgery, we invite you to contact our office to discuss your issues and how to move forward.
Though bariatric surgery has been shown to be a successful treatment for obesity, some policies will not provide coverage. To provide care for those without coverage, MASJax offers a competitive self-pay program. We also offer third party financing options for those without bariatric coverage or with high deductible plans. Please contact our team to discuss your options and how you can make weight loss surgery a reality. Please also keep in mind that policies can change their covered procedures from year to you or you may have different coverage options in the future.
Cigna can be contacted via their website or telephone. The best phone number to reach a representative for assistance should be listed on your insurance card. For other contact options: https://www.cigna.com/