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Cigna-HealthSpring PPO – Requirements For Weight Loss Surgery

In Am I Covered by OC Staff

Cigna-HealthSpring PPO Covers Weight Loss Surgery

Cigna-HealthSpring PPO covers weight loss surgery. To qualify for coverage of weight loss surgery, your policy must include coverage. If your policy does include coverage, the requirements below will apply.

Healthspring was acquired by Cigna. For more specific information, contact the company directly.

Cigna-HealthSpring also covers nutritional counseling with no out-of-pocket costs for anyone with a BMI over 30 and/or diabetics.


Cigna-HealthSpring PPO Pre-Approval Requirements

Morbid obesity can be effectively cured through a weight loss procedure. Keep in mind, the surgery will get your weight down to a manageable level. It is up to you to keep it off and implement a healthy lifestyle.

Members of Cinga-HealthSpring PPO plan have complete coverage for bariatric procedures. However, candidates need to fulfill the following requirements to be eligible for coverage.

  • Coverage will only be provided to morbidly obese patients who are over the age of 18.
  • Morbid obesity should have been diagnosed by a physician at least five years prior to the bariatric procedure.
    • This means that one of your doctors should have documentation that your Body Mass Index was over 35 at least 5 years ago.
  • To be considered for full coverage, the patient should have a Class III obese condition, i.e. the patient’s BMI should be over 40.
  • Patients with Class II obesity can also receive full coverage for a bariatric procedure provided they have at least one of the following co-morbid conditions.
    • Coronary artery disease
    • Type-2 diabetes
    • Obstructive sleep apnea
    • Hypertension
    • Impaired glucose tolerance
  • The patient will need to submit relevant documentation as proof that he/she has been a part of approved weight loss programs but without success. The weight loss programs the patient attempted should have been within the two years preceding the bariatric surgery.
    • Approved weight loss programs may include but are not limited to Jennie Craig and other medically supervised programs.
  • The patient will need to submit a letter of recommendation that confirms diagnosis of morbid obesity. The morbid obesity diagnosis and recommendation of  weight loss surgery should be provided by a physician other than the operating surgeon.

Types of Weight Loss Surgeries Covered By Cinga-HealthSpring PPO

Bariatric surgery proceduress covered by Cigna-HealthSpring PPO are:

  • Gastric Stapling
  • Gastric Bypass
  • Lap Band
  • Biliopancreatic Bypass (This is only for patients with a BMI in excess of 60)

If the patient meets all the requirements outlined above, Cigna-HealthSpring PPO covers the entire cost of the weight loss surgery procedure.

Procedures Excluded From Coverage

Cinga-HealthSpring PPO will not cover any procedures that are not outlined in the list above. Further details and queries can be attained from the member benefits chart. Page 58 shows coverage for bariatric surgery.

Is A Second Weight Loss Surgery Covered If Lap Band Doesn’t Work?

The guidelines for Cigna-HealthSpring PPO’s coverage do not provide specific information regarding the coverage of a second weight loss surgery.


Revisions to a bariatric procedure would be covered if the following requirements are met:

  • The post-surgery exercise and diet programs outlined by the surgeon were followed by the patient.
  • Failure to lose weight after the surgery should be due to a failure of the weight loss procedure itself.

Do I Have To Use An In-Network Bariatric Surgeon?

You do not have to use an in-network bariatric surgeon. However, you will need to get approval to use an out of network physician.

Your costs may be higher with an out of network hospital stay. There is a 15% out of pocket fee for in-network hospital stays and a 30% out of pocket fee for hospitals not in the Cigna-HealthSpring network.

Healthspring PPO Contact Info to Inquire About Surgery

To find out if your policy includes coverage, please talk directly to Cigna-HealthSpring PPO. Cigna-HealthSpring PPO can be reached at (800) 668-3813 for inquiries about weight loss surgery.


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