Insurance Information for Weightloss Surgery

To determine if your insurance policy covers obesity (or bariatric) surgery, refer to your insurance policy booklet or call your customer service agent.

Typically, there are two sections that describe the extent and limits of coverage. The first is usually called 'What Is Covered' or 'Covered Expenses.' These are the healthcare benefits for which the company will pay. Look for statements such as, 'Surgery for the treatment of obesity is covered when deemed medically necessary,' or 'Surgery for the treatment of obesity is (specifically) excluded except when medically necessary.' If this surgery is a covered benefit when medically necessary, then it should be covered when patients meet national guidelines for care for morbid obesity.

Most Frequently Requested Insurance Plans

* Download the Insurance Questionnaire form.

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Insurance Questionnaire

Important! Please use this form when calling your insurance company. Ask ALL questions and fill in all spaces as you talk with your insurance care specialist. Bring this completed form with you to your initial consultation with Dr. Johnny Perez or Dr. James Viglianco.

Name: _______________________________________________________________________
Insurance Company: __________________________________________________________
Insurance Company Phone Number I called: ______________________________________
Name of the customer service representative: _____________________________________
Call back number for the customer service representative: __________________________

Questions I Need to Ask:

1. Is there an exclusion for morbid obesity in my insurance policy? ____________________
2. Is morbid obesity (dx code: 278.01) a covered benefit in my policy? _________________
3. What is my benefit level for the treatment of morbid obesity up to and including surgery? (Is it 80/20? Is it 60/40?)___________________________________________________
4. Are the following CPT Codes included in my policy?
  • 43770 Laparoscopic, surgical, gastric restrictive procedure; placement of adjustable gastric restrictive device (eg. gastric band and subcutaneous port components)
  • 43775 Laparoscopic longitudinal gastrectomy, ie sleeve gastrectomy
  • 43644 Laparoscopic gastric bypass, short (< 100cm)
  • 43645 Laparoscopic gastric bypass, long (> 150 cm)
  • 43846 Open gastric bypass, short (< 100cm)
  • 43846 Open gastric bypass, long (> 150 cm)
5. What criteria must be met for approval? _______________________________________ _______________________________________________________________________
6. Do I need a psychiatric evaluation? __________________________________________
7. Do I need dietary consultation(s) prior to final approval? __________________________ If yes, how many? ________________________________________________________
8. Do I need chart notes of supervised dietary attempts and a letter from the physician who followed me? (How many, how recent, and how long must the attempts be?) _______________________________________________________________________
9. Are Dr.’s Johnny Perez and James Viglianco covered specialists in my insurance network? _______________________________________________________________
10. Is Thibodaux Regional Medical Center in my insurance network? ___________________
11. Is there any other information I haven’t mentioned that the insurance company is going to need? _________________________________________________________________
12. What is the fax number to where the medical documentation is to be sent for prior authorization? ___________________________________________________________

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