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Bariatric Insurance Coverage Options

We rarely hear positive news about health insurance coverage. But today, I have some good news for some of you seeking bariatric surgery. Cigna has made a major change in some pre-operative requirements to qualify for bariatric surgery.

First, some background. About 10-12 years ago, Medicare added a requirement to qualify for weight-loss surgery. Each patient had to attend 6 consecutive months of medically supervised weight-loss classes within the last 2 years to qualify for surgery. If you missed a class for any reason, you had to start all over. Each of the major insurance carriers quickly added this as a pre-operative requirement for their policies that provide bariatric surgery benefits.

Interestingly, there were no scientific studies to support this requirement at the time. In response, the medical community developed several studies to determine if a 6-month medically supervised weight-loss classes was impactful. Did the classes produce better overall outcomes for weight loss and fewer complications associated with surgery? These studies found no difference in weight loss success between patients who underwent a 6-month class versus patients with no classes. The studies also found that a delay in surgery led to some patients experiencing complications due to their medical co-morbidities.

Medicare was presented with the data from the studies for review and as a result dropped the requirement from its plan about 4-5 years ago. The major insurance carriers were provided with the same information, but continued with the requirement until this July. Cigna is the first to drop the 6-month medically supervised weight-loss class requirement. If you have Cigna insurance, this now means that if you have bariatric coverage and your primary-care physician or dietician can demonstrate an unsuccessful weight loss attempt, you will likely qualify for surgery. While there are still other standard requirements that you must meet, it does mean that surgery could occur in 4-6 weeks now instead of 3-6 months or more.

This decision by Cigna is a very positive step for patients who suffer from morbid obesity. This will improve access to weight loss surgeries like robotic bariatric surgeries, including the gastric bypass, sleeve gastrectomy, and revisional procedures. Such accessible care will lead to a reduction in, and resolution of, co-morbid conditions associated with obesity like type-II diabetes, hypertension, and sleep apnea. If you know anyone who works for Cigna, thank them. With such promising news, I am hopeful that other insurance companies will follow suit quickly. It will allow their morbidly obese patients to seek more efficient treatment and begin their weight loss and resolution of their co-morbid conditions. It is a win for everyone.

At the Colorado Bariatric Surgery Institute, all of our surgeries are performed with the most state-of-the art robotic instrumentation, allowing for a more precise operation with less pain and faster recovery. If you have questions regarding your insurance, please call our office at 303-861-4505. We do free insurance evaluations to help you determine your bariatric coverage.

Tom Brown, MD
Colorado Bariatric Surgery Institute in Denver, Colorado

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