Northwest Weight Loss Surgery, the leading center for Adjustable Gastric Band of the Lap-Band System for weight loss surgery

INSURANCE INFORMATION

Obtaining insurance authorization for weight loss surgery can be frustrating and time consuming. Some insurance policies do not cover any weight loss surgery, despite the fact it's endorsed by the National Institutes of Health as the only effective treatment for morbid obesity. 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 which weight loss procedure(s) your policy covers.
4. 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. We will then prepare a comprehensive letter of medical necessity outlining your situation and send it to your insurance company requesting approval for your weight loss surgery.

You need to take an active role in gathering this information! We recommend you document every step. It is becoming increasingly difficult to obtain coverage for weight loss surgery with some insurance companies, many require participation in a physician monitored weight loss program to qualify. Your chances of being approved for weight loss surgery are greatly improved if you gather the information. We'll submit a complete package of information for you covering all the insurance policy requirements together with our letter of medical necessity.

Educate yourself!

1. Research: The internet, specifically Walter Lindstrom's website, has some useful articles such as, "So you want to get your insurance company to cover surgery?" and a "Top Ten" list of what to do. Inform yourself about both the insurance issues and the surgical issues. Attend at least one support group. We have support groups at our center twice a month.
2. Personal information: You will need to know your height, weight, BMI, diet history and medical problems related to obesity. 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-9 Diagnostic Code for Morbid Obesity is 278.01, CPT Procedure Code is 43770, and Laparoscopy, surgical, gastric restrictive procedure; placement of adjustable gastric band (gastric band and subcutaneous port components).

Call your insurance company

Call the benefits coordinator at your human resource office and/or call the customer service line on your insurance card. State "I am inquiring about my policy benefits regarding the surgical treatment of morbid obesity. Is surgery for morbid obesity a covered benefit?" If they say no, there are two choices:

1. Once you are denied by your insurance, you may hire an attorney to help you prove that it is medically necessary. We recommend you contact Walter Lindstrom.
2. Self pay. Please feel free to contact us for further information on financing options that may be available to you.

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

• Telephone number and extension called: ____________________________
  
  Contact name: __________________________________________

• Is surgery for morbid obesity a covered benefit?   YES  /  NO

• Is the CPT code 43770 for laparoscopic adjustable gastric banding covered?   YES  /  NO

• Do you have a policy on surgery for morbid obesity that I can obtain?   YES  /  NO

• What information do you require before authorizing the surgery?

• Nutrition consult?  YES  /  NO
• Psychological consult?   YES  /  NO
• Medical clearance from a physician?   YES  /  NO
• Letter from surgeon?   YES  /  NO
• Documentation of weight loss attempts?   YES  /  NO
• Documentation of length of obesity?   YES  /  NO
• Medically supervised weight loss program?   YES  /  NO

• Is a medically supervised weight loss program required prior to approval? If yes, how long?

• 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.

Call us at 866-350-2263 & speak with one of our highly trained insurance experts!

Once you have contacted your insurance company and determined your benefits our insurance coordinators will be happy to walk you through the insurance authorization process for coverage of your Lapband® surgery.