INSURANCE AUTHORIZATION
The easiest way to determine insurance coverage of gastric band surgery is to call the office, 513-939-BAND, and ask to speak to our insurance coordinator. We are happy to assist you with this.
If you wish to explore insurance coverage on your own we have put together the following information to help.
We are pleased that you have chosen Cincinnati Weight Loss Center for your weight loss surgery. We are committed to providing a comprehensive weight loss surgery program involving surgical excellence as well as pre and postoperative education, evaluation, and support. We strongly believe that the best results are achieved when a comprehensive program is available to patients. We also realize that high quality weight loss surgery is expensive and people often have a difficult time paying for surgery when insurance companies deny coverage. Fortunately, there are several good financing options available and we can help with those. Some patients have financed band surgery for less than $300 per month.
Though insurance coverage of the surgery is often the best choice and the least expensive option, obtaining insurance authorization for weight loss surgery can be frustrating and time consuming. Despite the fact that weight loss surgery is endorsed by the National Institutes of Health as the only effective treatment for morbid obesity, some insurance policies do not cover it at all. The simplest thing to do is to call our office and our insurance coordinator will help you with this process. Obtaining insurance authorization usually involves the following steps:
1. Determine if weight loss surgery is a covered benefit in your policy.
2. Determine what the criteria for coverage are, such as weight, BMI, prior weight loss attempts, etc.
3. Obtain documentation (prior chart notes from your medical doctor are especially good) that you meet all the criteria for coverage required by your insurance policy.
4. Determine which weight loss procedure(s) your policy covers.
5. We will then prepare a comprehensive letter of medical necessity outlining your medical history and send it to your insurance company requesting approval for weight loss surgery.
6. You can take an active role in gathering this information. We have outlined the process in detail below to make it as simple and efficient as possible. We recommend that you document every step of the way.
Educate Yourself
Let us help you: The easiest way to navigate insurance coverage for surgery is to let us help you. Please call 513-939-BAND and speak to our insurance specialist. We have also helped patients successfully appeal denials of insurance coverage.
Personal information: You should know your height, weight, BMI, diet history and medical problems related to obesity. Some primary care physicians will write a supportive letter detailing the medical necessity for you. There are BMI calculators on many websites. 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 5 years and your prior weight loss attempts.
Understand the codes for weight loss surgery:
The ICD-9 Diagnostic Code for Morbid Obesity is 278.01
The most common CPT Procedure Code for Laparoscopic Adjustable Gastric Band Surgery (LAP-BAND, REALIZE band) is 43770
9075 Centre Pointe, Suite #160, West Chester, OH 45069
Toll Free: 1-800-979-6573
513-939-BAND
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