Insurance Coverage for Bariatric Surgery varies between insurance carriers and amongst individual plans from inside your insurance coverage company. In case your coverage supplies for bariatric surgery protection, you could also be required to supply documentation about your health historical past together with a letter from us indicating that the procedure is medically vital. In addition, many insurance companies even have particular necessities (corresponding to a physician supervised weight loss makes an attempt or psychological screening) that should be met prior to giving authorization for the surgical procedure.
Please, learn the next information to get began with the insurance process. Our Insurance Specialist is completely happy to help you with any questions you could have related to your particular situation and can work closely with you and your insurance firm all through the method. The CPT Procedure Code for adjustable gastric band is 43770. It refers to a “gastric restrictive procedure, without gastric bypass, for morbid obesity.” The process “unlisted laparoscopy process, stomach” can be used to refer to adjustable gastric band surgery. We request you to assist us in gathering your private well being information, together with top, weight, weight-loss plan-historical past and medical issues associated to obesity.
It may be obligatory for you to obtain a replica of your medical records from your Primary Care Physician to help do your weight history over the past 5 years and your prior weight loss attempts. Your private physician may also need to put in writing a letter of medical necessity for the proposed surgery.
We advocate that you contact your insurance company to search out out if weight loss surgery is a lined benefit. Ask which procedures they will approve/cowl, and in case your plan allows you to use out-of-network suppliers. Call the advantages coordinator at your human useful resource office and/or name the customer service line listed on your insurance coverage card. Once you’re connected to a consultant, ask the next questions to determine your policy advantages. Please, be aware that even when the representative states that bariatric surgical procedure is a covered profit, this isn’t a assured of protection or payment. 1. State, “I am inquiring about my coverage benefits regarding the surgical treatment of morbid obesity.
Is surgery for morbid obesity a lined profit? If the reply is “yes,” then ask what CPT procedure codes are covered and if this consists of the process you might be seeking. The supplier that I have chosen is a non-participating provider with all insurance corporations. Am I in a position to make use of non-collaborating/out-of-network suppliers?
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You might use the checklist under to help you ask all the questions and to document the answers obtained. 2. Is surgical procedure for morbid obesity a lined benefit? 3. Which CPT codes are covered? 4. Do you’ve got a policy on surgery for morbid obesity that I can receive? 5. Ask whether you are required to see an in-plan provider for the bariatric surgery.
After your preliminary consultation with the surgeon, we’ll put together a “Letter of Medical Necessity” to submit to your insurance coverage firm. This letter and a weight-loss historical past are mandatory to obtain prior authorization for obesity surgery. Insurance companies give shut consideration to an affected person who creates a detailed doc or packet listing their weight-loss makes an attempt (self-monitored or medically supervised) and the outcomes of those makes an attempt of their plea for insurance coverage for bariatric surgical procedure.
If protection has been denied upon the preliminary prior authorization request, you’ll be able to appeal by addressing the particular the explanation why your request has been denied. Our insurance coverage specialist can be blissful that can assist you with your appeal, ought to one be vital. You may also view a pattern appeals letter by clicking right here. Below is the checklist of insurance corporations that are recognized to either partially or fully cover weight loss surgery in Virginia, Maryland, and the Washington D.C. If your insurance company shouldn’t be listed under, it does not mean the procedure shouldn’t be coated by your insurance firm.
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