An accredited Bariatric Surgery Center

Insurance and Billing

Insurance Coverage and Bariatric Surgery 

Insurance coverage

Bariatric surgery is covered by many insurance plans. However, the amount covered depends on the type of policy and its terms. The cost of the operation includes hospital charges, surgeon fees, surgical assistant fees, anesthesiologist fees, lab charges, X-ray charges and consultation fees.  Insurance plan co-pays and deductibles vary, so it is important that you check with your insurance company directly.

Contact your insurance company to verify that your policy covers weight loss surgery.  Specifically, you should ask if the following procedures are covered by your insurance plan:

  • Sleeve Gastrectomy (CPT 43775)
  • Roux-en-Y gastric bypass (CPT Code 43644)
  • Laparoscopic Adjustable Gastric Band (CPT 43770) (Back to Top) (Back to Index)

The approval process

After all of your consultations are completed with your primary care physician, it usually takes the physician’s office a few days to send a letter to your insurance carrier to start the approval process. The time it takes to get an answer can vary from three to four weeks or longer, if you are not persistent in your follow-up. It may be helpful for you to call the claims service of your insurance company about a week after your letter is submitted and ask about the status of your request.

How to speed up the approval process

  • Select a primary care physician if you don’t already have one, and establish a relationship with him or her. Click here for assistance with finding a physician.
  • Work with your primary care physician to ensure that your routine health maintenance testing is current. For example, women may have a pap smear, and if over 40 years of age, a breast exam. For men, this may include a prostate specific antigen test (PSA).
  • Make a list of all the diets you have tried (a diet history) and bring it to your doctor.
  • Bring any pertinent medical data to your appointment with the surgeon – this would include reports of special tests (echocardiogram, sleep study, etc.) or hospital discharge summary if you have been in the hospital.
  • Bring a list of your medications with dose and schedule.
  • Stop smoking. Surgical patients who use tobacco products are at a higher surgical risk. (Back to Top) (Back to Index)

Documentation

Your wait will be dependent on whether you have already met the criteria for your insurance to cover your surgery. Typically, however, after you have attended one of our seminars, a one-on-one consultation can be scheduled with one of our surgeons within a week or two. Once you, your primary care physician and your surgeon agree that surgery is an appropriate option for you, the operation can usually be scheduled within four to eight weeks. This time is often necessary for insurance authorization and for you to have appropriate pre-surgical tests.

Most insurance companies require documentation of dieting and exercise program attempts. This includes formal documentation of items, such as a minimum of six months to one year of medically-supervised weight loss history (i.e., prescribed diet drugs, attempted diet plans and/or program records and documentation of exercise regimens).

Your insurance company will require official documentation for pre-determination, so you should begin gathering these records immediately.  Simply listing these items on the initial patient questionnaire will not suffice. Your physician’s records are required. 

Following the documentation process:

  • Predetermination: Your insurance company will go through a review process to determine if they will approve this benefit for you. 
  • Pre-certification: If your benefits for treatment have been approved, a final process of pre-certification through the insurance company is made. Pre-certification generally must take place within 90 days of predetermination to be valid.
  • Many insurance companies are now requiring a psychological evaluation. 
  • A consult with the bariatric surgeon is required to obtain clearance for surgery.  (Back to Top) (Back to Index)

Click here to register for a free bariatric surgery information seminarGeneral Bariatric Surgery Information:

Port Huron Hospital HealthAccess
Email HealthAccess
1.800.228.1484 (Michigan Callers)
1.810.989.3199

Patient Contact Information:

Port Huron Hospital
Bariatric Center of Michigan
Wismer 3rd Floor Clinic
1221 Pine Grove Avenue
Port Huron, MI 48060
810.989.3328