Cigna Modifies and Reduces the Medical Management Component of their  National  Bariatric Surgery Coverage Policy

This spring, in cooperation with our partners, the ASMBS Insurance Committee became aware that Cigna was reviewing their policy on medically supervised weight-loss prior to bariatric surgery.  The committee engaged each of the medical directors and supplied them with current and up-to-date information on the effectiveness of bariatric surgery and the lack of evidence supporting medically supervised weight loss.

On May 15, 2012 the new Cigna bariatric coverage policy was published and went into effect.  While not perfect, the new policy includes a reduction in the duration of the medical management from 6 consecutive months to 3 months.  In addition, the documentation requirement is much less complicated.  The text of the new requirement is below:

Medical management including evidence of active participation within the last 12 months in a weight-management program that is supervised either by a physician or a registered dietician for a minimum of three consecutive months. The weight-management program must include monthly documentation of ALL of the following components:

•  Weight
•  Current dietary program
•  Physical activity (e.g., exercise program)

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.

The entire new policy is at this link:  http://www.cigna.com/assets/docs/health-care-professionals/coverage_positions/mm_0051_coveragepositioncriteria_bariatric_surgery.pdf

While ASMBS has a lot of “ears to the ground”, if you become aware of an opportunity to engage any insurance company on coverage issues, the insurance committee is ready to help with letters or information to support the cause.

Don’t hesitate to contact the committee at insurance@asmsb.org.

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ASMBS Insurance Committee