Your Insurance: Cigna Healthcare
Cigna Healthcare issued a coverage policy for lipedema surgery effective June 2021. It published this policy due to the settlement of a lawsuit contending that Cigna failed to cover lipedema surgery adequately.
Coverlipedema.com has obtained coverage for Members with Cigna
We have helped many Coverlipedema.com members get fully covered with Cigna for liposuction and skin excisions. We have also secured coverage for panniculectomy or abdominoplasty for lipedema, even though not they are not explicitly covered in the Cigna lipedema coverage policy.
Cigna Coverage is not Easy
Still, Cigna seems concerned about the cost of widespread lipedema coverage and limits easy prior authorization and fair payment of lipedema treatment. While the coverage policy prevents a Cigna plan from arguing that liposuction for lipedema is experimental or unproven, it does not guarantee easy coverage. Our experience has shown that instead of issuing blanket denials, the Cigna HealthcareSM Coverage Review Department scrutinizes individual requests and denies them based on issues with diagnosis, conservative measures, or functional impairment. We recommend that you work with us from the beginning to minimize the risk of having to appeal a denial, which can be costly and time-consuming.
The Coverlipedema.com Process for Cigna
Even years after settling a lawsuit and issuing a coverage policy, Cigna has not properly trained its staff on lipedema, and some of its medical directors still believe that liposuction is a cosmetic, not medically necessary, treatment for lipedema. The Coverlipedema.com process walks members through all the required documentation, and we carefully review your prior authorization request to ensure nothing is missing or will affect your chance of approval. We then add additional support to your package so that a Cigna plan reviewer understands that you fully meet the coverage requirements.
We can often help Coverlipedema.com members avoid being denied in these cases by reaching out to our Cigna plan contacts, some of whom we have worked with for over five years. Also, employer policies can be a problem, so we help our members understand and navigate potential prohibitions on liposuction and skin excisions. We also ensure you have enough time to complete your surgery plan as requested by your surgeon.
The Importance of the Right Surgeon for Cigna
It’s far better to work with a plastic surgeon who we have vetted and recommend for being insurance-friendly. However, many plastic surgeons treating lipedema are not in-network with insurance but are insurance-friendly. They will not ask for full cash payment upfront for your surgery and will allow you enough time for you get a network exception, which is required before getting a single-case agreement.
Despite the lawsuit, Cigna has not updated its fee schedules for lipedema and tends to offer very low rates to plastic surgeons. These low rates can cause issues with getting an agreement signed. Depending on your state and type of plan, we can compel Cigna to cover and pay fairly.
Coverlipedema.com has the Resources to Challenge Cigna
However, network exceptions and single-case agreements are unusual and can be very hard for someone to get on their own, even with the help of a surgeon. Because we have been able to get help for hundreds of Coverlipedema.com members to get out-of-network coverage over the years nationally with different plastic surgeons, we have access to data, arguments, contacts at Cigna plans and regulators that most surgeons, other advocates, and Facebook groups do not have.
If we cannot get you to the surgeon of your choice because Cigna will not pay them fairly, we will help you find to an alternate plastic surgeon who is also safe and effective but can work with Cigna.
Your Next Step
Learn about choosing your surgeon.