how things work in order to have surgery, I figured I'd make a quick post about it.
Basically, I decided in July that I wanted to have WLS. I knew my insurance covered it since my mom who has the same insurance as me had Lap Band in February. But, I called the insurance company to ask for myself.
While the requirements will change per insurance company, here's what was required for me by Cigna: (This is simply copied and pasted from Cigna.com)
CIGNA covers bariatric surgery using a covered procedure outlined below as medically necessary when
ALL of the following criteria are met:
• The individual is ≥ 18 years of age or has reached full expected skeletal growth AND has evidence of EITHER of the following: a BMI (Body Mass Index) ≥ 40 , a BMI (Body Mass Index) 35–39.9 with at least one clinically significant comorbidity, including but
not limited to, cardiovascular disease, Type 2 diabetes, hypertension, coronary artery disease, or pulmonary hypertension
• Failure of medical management including evidence of active participation within the last two years in a weight-management program that is supervised either by a physician or a registered dietician for a minimum of six months without significant gaps. The weight-management program must include monthly documentation of ALL of the following components: weight, current dietary program and physical activity (e.g., exercise program)
I also had to meet with a nutritionist twice. And, have a psychological evaluation done.
My surgeon had to write a report also. And, just to have extra documentation I had my Primary Care Doctor write me a letter stating it was medically necessary.
So once I found all this out, I decided to go online and find a surgeon. Originally, I wanted the LapBand so I went on to Lapband.com and registered for a seminar. It is required to attend this education seminar.
Once I changed my mind about the Lapband I followed up with the insurance company to make sure they covered the Gastric sleeve (or VSG) Which they did.
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