Insurance Coverage

Will My Insurance Pay for Weight Loss Surgery?

Patients often ask if their insurance will pay for weight loss surgery. The answer to this question varies; it is based on each individual’s insurance company and policy.

We recommend checking on your policy before your first visit.

 

Questions to Ask Your Health Insurer

    1. What is the exclusion criteria for my plan with regards to weight loss surgery?
      Every insurer has exclusion criteria that explains what the company will or will not cover. For example, if a policy states that it excludes the surgical treatment of obesity, then it may not pay for a weight loss operation or any tests or clinical visits related to the surgery.

 

    1. What portion of the hospital, surgeon and anesthesiologist’s bill will be covered?
      Some plans will cover 90% others 80%. With some plans you may have a fixed deductible that you must pay each year.

 

    1. Are dietitian visits for pre- and post-op medical nutrition counseling covered in my plan?

 

    1. Is the cost of airfare related to clinic appointments covered?
      This is applicable if you are a neighbor island resident.

 

  1. Is there specific criteria I must meet prior to surgery?
    For example, some plans require that a patient sees a dietitian once a month for six consecutive months, or participate in a physician directed exercise program for at least six months.

Useful Information When Speaking With Your Health Insurance Company

When speaking to your health insurer, your insurance company may need something called a CPT code. The CPT code will depend on which surgical procedure you and your surgeon choose. The CPT codes for weight loss surgery are:

  • 49644 Laparoscopic Roux-en Y Gastric Bypass
  • 43770 Laparoscopic Placement of an Adjustable Gastric Band
  • 43775 Laparoscopic Sleeve Gastrectomy

Learn more about the different types of bariatric surgery here.