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Weight Loss Surgery Insurance Information

Weight Loss Surgery Insurance  Information

Weight Loss Surgery may be covered by your health insurance policy.

*CLICK HERE FOR A COMPLIMENTARY INSURANCE VERIFICATION*

At some point, after you have spent a considerable amount of time exploring the option of weight loss surgery, you will need to determine how to pay for the surgical procedure. Insurance coverage is one of the biggest concerns among bariatric patients. The fact that your primary care doctor and or surgeon feels surgery is medically necessary and that you meet the surgical eligibility criteria does not automatically mean that your insurance company will pay for surgery. The surgical coverage benefit is primarily determined by the policy holder’s employer, not the insurance company.

With insurance benefits for weight loss surgery, the criteria can vary between individual insurances. If your insurance does have benefits for weight loss surgery, Northwest Weight Loss Surgery is here to help you navigate through your insurance requirements. If your weight loss surgery is denied, we will work with you to appeal the decision in the attempt to get it overturned. 

Some insurance companies have exclusion clauses for the treatment of obesity; meaning they will not cover the procedure no matter what the circumstance.

What does the insurance cover? 

If the patient has benefits for the surgical treatment of morbid obesity and is a qualified candidate for Weight Loss Surgery, insurance will typically cover most of the cost.

Obtaining insurance authorization usually involves the following steps:

  1. Determine if weight loss surgery is a covered benefit in your policy.
     
  2. Determine the criteria for coverage (such as weight, BMI, previous weight loss attempts, etc.).
     
  3. Determine if they require participation in a medically supervised weight loss program.
     
  4. Determine which weight loss procedure(s) your policy covers.
     
  5. Obtain documentation (such as chart notes from previous doctor visits) that you may need to meet all the criteria for coverage by your insurance policy.
     
  6. We will then prepare a comprehensive letter of medical necessity outlining your situation and send it to your insurance company  on your behalf requesting approval for your weight loss surgery.

If your insurance company requires participation in a physician monitored weight loss program prior to surgery, we will schedule these visits with our providers.  

Educate Yourself

  1. Research: The internet is a useful place to gather information about weight loss surgery and insurance coverage.  Walter Lindstrom’s website, www.obesitylaw.com, has some useful articles such as, “So you want to get your insurance company to cover surgery?”  He also has a “Top Ten” list of what to do.  Inform yourself about both the insurance issues and the surgical issues.  Attending at least one support group is strongly encouraged.  This is where you can ask important questions of other patients who have had similar experiences.  We have support groups at our center three times a month.
     
  2. Personal information: You will need to know your height, weight, BMI, diet history and medical problems related to obesity.  Some primary care physicians will write a supportive letter detailing the medical necessity for you.  There is a BMI calculator on our website.  Bring your insurance card with you to your appointment.  We recommend obtaining a copy of your medical record from your primary care physician to help document your weight over the last five years and your prior weight loss attempts.
     
  3. Understand the codes for weight loss surgery:

    ICD-10 Diagnostic Code for Morbid Obesity is E66.01 

    CPT Procedure Codes for weight loss surgery: 
    • 43770 - Adjustable Gastric Band
    • 43775 - Sleeve Gastrectomy
    • 43644 - Gastric Bypass or Roux-en-Y Gastric Bypass

Call your insurance company

  1. Call the benefits coordinator at your human resource office and/or call the customer service number on your insurance card. 

  1. State “I am inquiring about my policy benefits regarding the surgical treatment of morbid obesity.  Is surgery for morbid obesity a covered benefit?”   

You may use the list below to help you ask all the questions and to document the answers received from your insurance company.

  1. Telephone number and extension called / Contact name
     
  2. Is surgery for morbid obesity a covered benefit?
       
  3. Are the CPT codes 43770 (Gastric Band) 43775 (Sleeve) or 43846 (Gastric Bypass) for weight loss surgery covered in my plan benefits?
     
  4. Do you have a medical policy for bariatric surgery that I can obtain?
  5. What information do you require before authorizing the surgery?
    1. Nutrition
    2. Psychological consult
    3. Medical clearance from a  physician
    4. Letter from the bariatic surgeon
    5. Documentation of weight loss attempts
    6. Documentation of length of obesity
  6. Is a medically supervised weight loss program required prior to approval? If yes, how long?
     
  7. Am I required to see a contracted provider or can I go out of network?

Remember to get the full name and direct extension of the person you talked to.

Once we have determined your benefits our insurance coordinators will be happy to walk you through the insurance authorization process for coverage of your weight loss surgery.

Some insurance companies specifically exclude weight loss surgery or treatment for obesity-related services. We are unable to bill insurance companies that state these exclusions.  If your insurance has this type of exclusion, you have the option to become a self-pay patient. 

Information on Self-pay weight loss surgery:

Convenient Scheduling: As a self-pay patient, you can begin the process as soon as you want without having to wait for insurance approval or protocol.

Payment Options: Northwest Weight Loss Surgery has teamed up with CareCredit, Lending Club, and Medicard to offer payment plans for bariatric surgery. Although we do not offer in-house financing, we are happy to accept money orders, cashier’s check, debit card, and all major credit cards. It is also possible to utilize funds from your 401K plan for a medical expense (See IRS medical hardship).

BLIS Protection: BLIS is an exclusive program offered only by select surgeons who qualify based on strict standards. BLIS isn’t health insurance, but rather a specialty insurance that provides financial protection for you against cost that may arise from specific complications. BLIS coverage can alleviate concerns regarding unexpected medical cost of your surgery.

Tax Relief: Generally, you can deduct on Schedule A (Form 1040) only the amount of your medical and dental expenses that is more than 10% of your adjusted gross income (AGI). But if either you or your spouse was born before January 2, 1952, you can deduct the amount of your medical and dental expenses that is more than 7.5% of your AGI. (More information)

Additional Procedures:  At the time of your bariatric surgery, your surgeon may discover another condition that requires treatment. Examples would include (but are not limited to) a hiatal hernia or a mass that requires biopsy. If this is the case, the surgeon will perform the additional procedure. If the additional procedure is covered by your insurance, Northwest Weight Loss Surgery will bill the procedure to your insurance company, even if your bariatric procedure was self-paid.

There are now many reasons to consider weight loss surgery that go beyond the long term health benefits. Studies have proven that patients who have undergone bariatric surgery go on to earn more money, advance their careers at their current job and see less discrimination in the overall job market.

Northwest Weight Loss Surgery accepts most insurance plans. Please bring your insurance card to the seminar and we will provide you with an insurance verification form. Our insurance coordinators will then contact your insurance provider to verify your benefits, criteria and deductibles. Northwest Weight Loss Surgery is dedicated to assisting you through every step of the weight loss surgery process. If you are unable to attend a seminar and would like us to help you explore the benefits of your insurance plan, please call our office to provide your insurance information.

Your answers are just a call away.

Call us now at 425-385-2263

Attend a free seminar to learn more about your options

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Are you unsure about your insurance benefits?

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Stay Connected

Support groups should play an important part in your preparation, recovery and long-term goals. We are here to assist you every step of the way. Email your questions to info@nwwls.com

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  • BLIS
  • MBASQIP
  • American Board of Obesity Medicine
  • American College of Surgeons