1. 475 POINTS
    Barry Cohn
    President, RGEB Employee Benefits, Los Angeles
    Gastric Bypass surgery may be covered by your health insurance carrier if it is deemed to be medically necessary.  For this type of surgery medically necessary usually means morbidly obese where an individual is more than 100 pounds overweight.

    Surgeons that perform this type of surgery usually understand the rules and they can assist you with further information.

    In addition you should refer to your Evidence of Coverage that spells out what is and is not covered.
    Answered on April 28, 2014
  2. 5527 POINTS
    Marlin McKelvy
    President, Consumer Directed Benefit Solutions, Memphis, Tennessee
    Most CIGNA health policies will cover gastric bypass surgery.  However, the reader should note that CIGNA also administers self-funded health plans where the employer can define many elements of coverage and that it is possible that some much older fully insured plans still exist where such surgery was excluded or significantly limited.  So check your certificate of coverage first or call CIGNA member services for guidance on this issue for your specific policy.

    In general terms, while gastric bypass surgery is covered, it is as more of a last resort than as a first course of action because this is a serious surgical procedure that is not without complications.  The candidate will have to meet several criteria for pre-approval by CIGNA for this procedure to be approved for coverage and you will have to show that other, less invasive methods of weight loss have been tried and found to be ineffective.
    Answered on April 28, 2014
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