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Insurance Information
More and more insurance companies are changing their view on bariatric surgery and viewing it as a "covered benefit." This change may be based on a broadening perception of obesity as a medical problem (as opposed to a bad habit or failure of moral character) and increasing understanding of the health cost savings from bariatric surgery. For patients who are unsure about whether their plan covers gastric bypass surgery, the first thing to do is read your insurance policy to see if it mentions "gastric stapling surgery" or "bariatric surgery." If the policy is not informative, you should call the insurance company and ask to speak to the Benefits Department. Ask if the procedure code CPT 43846 (Roux-en-Y Gastric bypass) or 43659 (Lap-Band) is a covered benefit - be sure to clarify that you are asking about the procedure on the basis of medical necessity.

For insured patients, the Midwest Bariatric Solutions office will submit a pre-authorization request letter to the insurance company after the patient attends our informational seminar. The patient will be contacted to arrange a multidisciplinary evaluation (surgeon, dietician, and psych CNS) once insurance approval is obtained. The wait for insurance approval is understandably frustrating for our patients, especially since the insurance company turnaround can be up to eight weeks.

Sometimes a patient really ought to be covered by insurance, but the company refuses. In these situations it may be appropriate to obtain legal assistance. One useful source of such assistance is the Obesity Law and Advocacy Center.

Our staff will bill the insurance company on behalf of the patient, however most patients are responsible for co-payments at the time of initial consultation, and deposits prior to surgery. Anticipated co-pays for the surgical procedure must be submitted at the time of the pre-operative preparation appointment, usually about 1 week before surgery.

The first step is to contact your insurance company to determine if the weight loss surgery procedure is covered under your plan. Not all insurance companies will cover weight loss surgery.

If it is covered, you'll want to ask, "What is the coverable benefit under my plan for this procedure?" and "What will I, the patient, be responsible for financially?"

Midwest Bariatric Solutions will work closely with you and, when appropriate, will write letters of recommendation for you to be approved for the surgery.

Insurance requirement checklist
In order to process the pre-authorization for gastric bypass surgery, your insurance company and our office require the following information:
1. Psychological evaluation from a psychologist
2. Documentation from your Primary Care Physician describing any co-morbidities.
3. Documentation from your Primary Care Physician, detailing all supervised weight loss attempts (i.e. Weight Watchers, Nutrisystem, etc.) within the last two years.
4. If you have sleep apnea, you must provide documentation from your Pulmonologist describing treatment.
5. If you have ever had cardiac (heart) problems of any kind, we need the results of any tests conducted. If you have or are seeing a Cardiologist, we need a letter clearing you for surgery.
6. If you have ever been on Fen/Phen, we need you to have an Echo cardiogram.
 
Our letter of medical necessity cannot be submitted to the insurance company without the above listed information.

If you have additional questions regarding insurance, click here.
 
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