 Insurance
Insurance Information
 Although weight loss surgery is endorsed by the National Institutes of Health as the only effective treatment for morbid obesity, not all insurance policies cover the cost of weight loss surgery. Those that do will often require that you provide extensive documentation about your health, along with a letter from one of our physicians stating that your surgery is a "medical necessity."
If your insurance company does not cover LAP-BAND or the Gastric Bypass surgery, financing may still be available.
(To learn more about financing options please click here).
Start By Educating Yourself
The Internet can help you gather information about weight loss surgery and insurance coverage. We recommend visiting the Obesity Law and Advocacy Site (obesitylaw.com) and reading (in the Library section) the article "Maximizing Your Chances of Getting Insurance Approval."
Attend at least one support group meeting to ask patients who have had the surgery about insurance coverage.
Gather your personal health information, including height, weight, BMI, diet history and medical problems related to obesity. You will also be obtaining a copy of your medical record from your primary care physician to help document your weight over the last 5 years and your prior weight loss attempts, and asking your doctor to write a letter stating the need for weight loss surgery.
Know the codes for weight loss surgery:
The ICD-9 Diagnostic Code for Morbid Obesity is: 278.01
The CPT Procedure Code for LAP-BAND surgery is: 43770. It refers to a "gastric restrictive procedure, without gastric bypass, for morbid obesity." The procedure "unlisted laparoscopy procedure, stomach" is also used to refer to LAP-BAND surgery.
Getting Insurance Authorization
We recommend that you contact your insurance company to find out if weight loss surgery is a covered benefit, which procedures they will approve, and if you are allowed to select the surgeon you prefer. Use the checklist below to document the numbers you call, the people you speak with, and the time and date you speak with them. Bring the completed checklist this with you to your office appointment at The Weigh Loss Institute of Arizona.
Calling your insurance company
Call the benefits coordinator at your human resource office and/or call the customer service line listed on your insurance card. State "I am inquiring about my policy benefits regarding the surgical treatment of morbid obesity. Is surgery for morbid obesity a covered benefit?"
If the answer is "no," you may need an attorney to help you prove that it is medically necessary. We recommend you contact the Obesity Law and Advocacy Center (http://www.obesitylaw.com).
If the answer is "yes," then ask what CPT procedure codes are covered and if this includes LAP-BAND surgery (CPT 43770).
Finally, ask them to send you a copy of their policy on the surgical treatment of morbid obesity (ICD 9 code 278.01).
You may use the list below to help you ask all the questions and to document the answers received.
| 1. |
Telephone number and extension called |
|
| 2. |
Is surgery for morbid obesity a covered benefit? |
Yes |
No |
| 3. |
Which CPT codes are covered? |
|
| 4. |
Is CPT code 43770 LAP-BAND covered? |
Yes |
No |
| 5. |
Do you have a policy on surgery for morbid obesity that I can obtain? |
| 6. What information do you require before authorizing the surgery? |
| Nutrition consult required? |
Yes |
No |
| Psychological consult required? |
Yes |
No |
| Medical clearance from your physician |
Yes |
No |
| Note from Surgeon |
Yes |
No |
| Documentation of weight loss attempts |
Yes |
No |
| Documentation of length of obesity |
Yes |
No |
| |
|
|
| 7. Get the full name and direct telephone extension of the person with whom you spoke |
|
