Is there a way to avoid the serious health complications associated with diabetes? Absolutely. Our diabetes management specialist talks about steps you can take now to get your blood sugars under control before Type 2 diabetes takes over your life.
If you’re trying to decide whether or not to get bariatric surgery, cost is a very important factor. Bariatric procedures in the USA typically cost well over $10,000, and most people are not able to simply pay that in cash.
As a result, the next question that most patients ask is “Does my insurance cover bariatric surgery?” Unfortunately, the answer to this question is not exactly straightforward, and finding out on one’s own will require several steps.
But first, let’s go over how bariatric surgery works with health insurance in the US.
The simple answer to this question is “probably”. Most insurance plans cover weight loss surgery, provided that certain conditions are met before getting the surgery.
Bariatric procedures, in general, are covered as elective procedures. But not all plans cover weight loss surgery, and not all providers cover every procedure. For a long time, gastric sleeve surgery and many reversible procedures (such as Lap-Band and gastric balloon) were excluded as they were experimental procedures. Nowadays, things have changed and gastric sleeve surgery is covered by most insurance providers.
It’s still important that you check whether or not your insurance covers the procedure you want.
Here’s how to find out.
Call your insurance provider and ask if obesity is a covered benefit under your individual policy. If so, you should be able to get bariatric surgery covered by your insurance.
ICD10 code: E66.01 (morbid obesity) or E66.0 (obesity, unspecified BMI)
If obesity is a covered benefit, you want to figure out whether the procedure you want is covered. Use the following codes to figure out if your insurance will cover a particular procedure:
Gastric bypass: CPT 43644
Gastric sleeve: CPT 43775
Duodenal switch (BD-DS): CPT 43645
If you’re planning on using us, contact us and we’ll tell you what you need to say to your insurance.
Most insurance companies have the following requirements for coverage:
Other requirements may include:
Switch to another carrier during open enrollment. Do your research about available coverage options.
Pay cash for your surgery. There are options for financing your surgery, including taking out loans to do so. If you’re considering paying cash for surgery and you’re getting the procedure with us, call us at 702-637-1973 to discuss your available options.
Make sure to contact your own health insurance provider to get the actual answers to your insurance questions. None of the above is a guarantee of coverage. If you have specific insurance-related questions regarding procedures performed at Southern Nevada Bariatrics, give us a call at 702-637-1973.
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