Insurance Information


 

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There’s only one way to find out if your weight loss or bariatric surgery at our Phoenix area and Tucson offices is covered for sure and that is to review your health plan policy. Upon review, it is recommended to confirm with your health insurance company to see if weight loss surgeries such as gastric bypass surgery, gastric sleeve or the LAP-BAND® procedure are covered.

Some permanent weight loss procedures which reduce health risks can be made more apparent by your surgeon so that your insurer can consider it covered.

Although weight loss surgery is endorsed by the National Institute 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.”

Start By Educating Yourself

The Internet can help you gather information about weight loss surgery and insurance coverage. We recommend 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-10 Diagnostic Code for Morbid Obesity is: E66.01

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.

The CPT code for Gastric Sleeve is: 43775.

The CPT code for Gastric Bypass is: 43644.

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 Weight 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.

If the answer is “yes,” then ask what CPT procedure codes are covered and if this includes LAP-BAND® surgery (CPT 43770), Gastric Sleeve (CPT 43775), Gastric Bypass (CPT 43644).

Finally, ask them to send you a copy of their policy on the surgical treatment of morbid obesity (ICD 10 code E 66.01).

You may use the list below to help you ask all the questions and to document the answers received:

  Telephone number and extension called:

 

  Is surgery for morbid obesity a covered benefit?

 Yes No 

  Which CPT codes are covered?

 

  Do you have a policy on surgery for morbid obesity that I can obtain?

 

  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 the surgeon?

 Yes No 

  Documentation of weight loss attempts?

 Yes No 

  Documentation of length of obesity?

 Yes No 

  Get the full name and direct telephone extension of the person with whom you spoke.

 
 

Free Seminars

Visit one of our FREE Seminars to learn more about the LAP-BAND®, sleeve gastrectomy as well as other surgical weight loss procedures. Our friendly staff will be with you every step of the way.

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*The testimonials, statements, and opinions presented on our website are only applicable to the individuals depicted, and may not be representative of the experience of others. The testimonials are not indicative of future results or success of any other individuals. Weight Loss Institute of Arizona’s impendent practitioner affiliates cannot and do not guarantee the medical outcome or the results of individuals utilizing the services provided by Weight Loss Institutes of Arizona practitioners. The testimonials and endorsements found on the site for the benefit of the site or individual services or procedures are, to the best of our knowledge, the true statements and beliefs of the individuals providing them. These are the opinions of the patients and do not necessarily reflect the views of WLIAZ. In short, surgery involves risk, results vary from patient to patient, and outcomes are not guaranteed.

Weight Loss Institute of Arizona is a marketing and administrative firm. Our surgeons are independent physicians engaged in the private practice of medicine. WLIAZ.com does not provide medical or any other health care or fitness advice, diagnosis, or treatment. The site and its services, including all content contained on this site, are for informational purposes only and are not intended to be a substitute for professional medical or health advice, examination, diagnosis, or treatment. Always seek the advice of your physician or other qualified health professional before starting any new treatment, making any changes to existing treatment, or altering in any way your current exercise or diet regimen. Never delay seeking or disregard medical advice based on information you have read on this site. Medical information changes rapidly and reliance on any information provided by WLIAZ.com is done solely at your own risk.

Weight Loss Institute of Arizona surgeons are independent practitioners and members of our provider network. Please refer to individual surgeon biographies for more information about them and MBSAQIP Accredited designation.

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Product names may be mentioned in testimonials or elsewhere, and are trademarks or registered trademarks of their respective holders. Please refer to our Terms and Risks of Surgery pages for more information.