Insurance
Many insurance companies have weight loss surgery as a covered benefit. However, obtaining an approval can be a time consuming and extremely frustrating process. As our insurance specialists will help with the approval process, we ask that you are actively involved, too. First, you need to know if weight loss surgery, specifically Lap-Band® is covered in your policy. The more information you can get and the more informed you are, the better chance you have of getting approved by your insurance.
You will need to ask these questions:
- Is weight loss surgery a covered benefit?
- The ICD-9 code for morbid obesity is 278.01
- The procedure code for Lap-Band is 43770
- Can you select any surgeon?
- What is the criterion needed for coverage? (Examples are as follows)
- Specific weight and BMI
- Health problems
- 5 year documented history of morbid obesity
- Medically supervised diet history
- Documentation of weight loss attempts
- Psychological evaluation
- Nutritional evaluation
Every time you call, make sure you document the number called, the date you called, and the person to whom you spoke. You may also want to request the specific information in writing.
After we have gathered the needed documentation, we will write and send a Pre-Determination letter, indicating medical necessity. It might take 6 — 8 weeks to hear back from your insurance carrier. During this time, we recommend that you call to check on the status of your Pre-Determination letter. We need you involved in this process.
Once we have an approval letter, we can proceed to schedule your surgery. Should your surgery be denied, we will talk to you about the appeal process.
The more you know about weight loss surgery and the process involved, the better off you are. The internet is a terrific resource of information. We have provided a variety of links that you may find useful. Another useful source is Obesity Law and Advocacy Center (www.obesitylaw.com). Walt Lindstrom, attorney and bariatric patient, has dedicated his life to fighting for the rights of the obese patient. His website is a good source of information, including "so you want to get your insurance company to cover surgery?".