Many insurance companies will cover the cost of Bariatric surgery however they do require that we provide them with documentation that your surgery is medically necessary. We are very familiar with the insurance companies that cover weight reduction surgery and their requirements so please don’t hesitate to contact us at anytime. As you may know, insurance companies are becoming very particular regarding coverage of any surgery for weight reduction. The more documentation submitted to them supporting your medical necessity, weight loss attempts and struggle to lose weight, the better your chances are of approval.
Once you have met all the criteria required by your insurance company and our program, the Bariatric clinic will submit this documentation to your insurance company for approval. You will not meet with the surgeon, until we have received a written letter of authorization from your insurance company approving the procedure. Once this letter is received, we will send a copy of the letter and your record to the surgeon’s office and they will contact you to set up the appointment. Please note: Average time for response from an insurance company is 4 weeks however it can range from 2-8 weeks.
Your initial appointment with our clinic is with our Nurse Practitioner who will do a complete evaluation and assessment of your medical history and previous weight loss attempts. An individual plan will be developed based on this information as well as our program and your insurance company requirements. Here are some helpful steps to be aware of and assist you in this process:
Before your initial appointment with the Bariatric clinic, please read your policy and call your insurance company to verify that “surgical treatment of obesity” is a covered benefit and is not a direct exclusion in your insurance plan and please verify that Bellin Health and Surgery Specialists of Green Bay are covered in your plan. Please note that if bariatric surgery is a benefit under your policy, it is usually covered per “medical necessity” and your insurance will review each request individually; unfortunately, just because it is a covered benefit it does not guarantee coverage.
Insurance companies may ask for the codes for this surgery. The procedure code (CPT) for the Roux En Y Gastric Bypass is 43646 and the diagnosis code for Morbid Obesity is 278.01.
If bariatric surgery is a covered procedure, ask your insurance company if they have any specific criteria that they require prior to surgery and request a copy be sent to you.
Always document the date, time and name of person you talked with and ask for a contact or department name, address, telephone and fax number. This will assist us in sending your information to your insurance company.
You must bring your insurance cards to all your appointments.
Although we accept most insurance plans for this surgical procedure, we don’t accept Medicare, Medicaid, Tricare or HIRSP for this elective surgery. We can assist you in finding a list of surgeons who do accept these insurances.
