Verify Insurance Coverage
Your insurance coverage paves the way for your weight loss journey. With the help of an authorization specialist, our [MINISTRY] will guide you every step of the way. However, we encourage you to be as prepared as possible with all insurance-related matters. Below is a helpful list of topics and resources to consider.
Insurance Coverage Considerations
Bariatric surgery coverage varies by health insurance policy, but there are several considerations to take into account regardless of your provider. To qualify for any weight loss procedure, you must be at least 18 years old and have a Body Mass Index (BMI) of 35 or higher. If your BMI is less than 40, you must suffer from a major, weight-related health issue to qualify for surgery. If your BMI is more than 40, you do not need to suffer from a weight-related health issue to qualify.
Most insurance plans also require a physician-supervised weight loss trial and a copy of one office visit note for each of the last 3 to 5 years listing your weight, to demonstrate your obesity has been a long-term health issue. Your provider will have more details.
Check with your insurance CPT (Current Procedural Terminology) codes XXXXXX and XXXXXX.
Insurance Coverage Checklist
Before working with our authorization specialist, we highly recommend contacting your insurance provider to verify your bariatric surgery coverage and any plan limitations. Here are some common questions you can ask your provider over the phone:
- Is bariatric surgery covered on my insurance plan or is it an exclusion? Will my plan cover any complications?
- What is my deductible? What is my out of pocket? Is my deductible applied to my out of pocket?
- Does my insurance cover CPT codes XXXXX and XXXXX?
- What type of weight-loss documentation do I need to qualify for surgery?
- Do I need a pre-surgery psychiatric evaluation? Is this covered?
- Does my plan offer gym membership and/or healthy-living discounts?