Insurance and Financing
The Cost of Obesity
Many people don’t realize that the cost of weight loss surgery is relatively small compared to obesity-related costs. You may also find that dramatic weight loss can greatly reduce weight-related costs. Take a few minutes to think about how much you can save by losing weight and improving your overall health.
Though insurance coverage of the surgery is often the least expensive option for you, 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.
Why do some insurance companies deny coverage for band surgery?
Over time, health insurance companies are learning about the many benefits of gastric band surgery and its minimal risk of serious complications. Insurance coverage continues to increase over time but some people still encounter difficulty when seeking insurance coverage of the procedure. We have experienced insurance coordinators in the office to assist you with this process.
We will work with you to obtain insurance authorization for your treatment. Obtaining insurance authorization usually involves the following steps:
- Determine if weight loss surgery is a covered benefit in your policy.
- Determine what the criteria for coverage are (such as weight, BMI, previous weight loss attempts, etc.).
- Obtain documentation that you meet all the criteria for coverage required by your insurance policy.
- Determine which weight loss procedure(s) your policy covers.
- We will then prepare a comprehensive letter of medical necessity outlining your situation and send it to your insurance company requesting approval for your weight loss surgery.
You need to 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.
Inform yourself: The internet is a useful place to gather information about weight loss surgery and insurance coverage. You should review obesitylaw.com. Go to the Articles Section and review “so you want to get your insurance company to cover surgery?” Walter Lindstrom has a “top ten” list of what to do. Inform yourself about both the insurance issues and the surgical issues. Attending at least one support group is strongly encouraged. This is where you can ask important questions of other patients who have had similar experiences.
Personal information: You should know your height, weight, BMI, diet history, and medical problems related to obesity. Bring your insurance card with you to your first appointment.
Understand the codes for weight loss surgery:
- The ICD-9 Diagnostic Code for Morbid Obesity is 278.01
- The CPT Procedure Codes is 43770: “Gastric restrictive procedure, without gastric bypass, for morbid obesity; other than vertical-banded gastroplasty (such as LAP-BAND), Unlisted laparoscopy procedure, stomach. Also used for (adjustable gastric banding).”
We recommend that you contact your insurance company to find out if weight loss surgery is a covered benefit, which procedures they will approve, and if you are allowed to select the surgeon you prefer. Use the checklist below to help you, and be sure to document below every number you call, every individual you speak with, and the time and date that you spoke with them. Bring this with you to your office appointment.
Call your insurance company
Call the benefits coordinator at your human resource office and/or call the customer service line on your insurance card. State “I am inquiring about my policy benefits regarding the surgical treatment of morbid obesity. Is surgery for morbid obesity a covered benefit?” If they say no, you may need an attorney to help you prove that it is medically necessary. We recommend you contact Walter Lindstrom at Obesitylaw.com (see above section, Inform Yourself). If they say yes, then ask them what CPT procedure codes they cover. The adjustable gastric band procedure code that you would be inquiring about is CPT 43770. Don’t forget to document this. Finally, ask them to send you a copy of their policy on the surgical treatment of morbid obesity (ICD-9 code 278.01).
You may use the list below to help you ask all the questions and to document the answers received.
- Telephone number and extension called:
- Is surgery for morbid obesity a covered benefit?
- Which CPT codes are covered? 43770-adjustable gastric band?
- Do you have a policy on surgery for morbid obesity that I can obtain?
- What information do you require before authorizing the surgery?
- Documentation of weight loss attempts?
Ask whether you are required to see an in-plan provider or a contracted provider. This may make it more difficult for you to be approved to see us as we are currently out of network with some insurance companies. A helpful website to assist you with insurance coverage is obesitylaw.com.
Get the full name and direct extension of the person with whom you spoke.
What we will do
After your initial appointments, we send a letter of medical necessity to your insurance company requesting authorization for surgery. You will also be asked to sign an “Advanced Beneficiary Notice”. This document will state that you agree to pay Synchrony Chicago Weight Loss in full, two weeks in advance of the date of surgery, if you are paying privately for surgery; if your insurance company is approving your surgery, your insurance policy out of pocket costs will be due two weeks before surgery. You will also be required to make an appointment with the financial specialist at Synchrony Chicago Weight Loss to arrange financial matters with the hospital or surgical center. In some cases, your insurance company will cover the surgery, but we may be out of network. We will always try to advise you of what your chances are of being approved. We will also try to advise you on what to expect in terms of the timing and amount of reimbursement from the insurance company. If weight loss surgery is not covered by your insurance we will help you arrange financing, if you are interested.
Your chance of being approved for weight loss surgery by your insurance company will be greatly improved if you gather the information above, and we submit a complete package of information covering all the insurance policy requirements together with our letter of medical necessity.
For further information on costs and other inquiries regarding our financial policy, please feel free to contact our office at (630) 990-2440.
Self Pay and Financing
Many patients choose to go the self pay route based on either bariatric surgery being excluded from their insurance coverage or the delays brought on by their insurance approval process. We strive to work with you to make the process of planning your surgery as simple as possible. We have possible financing options available to our patients, if they choose.
There are various companies that specialize in Healthcare Financing and will finance this type of surgery. Here are just a few that we at Synchrony Chicago Weight Loss and our patients have worked with:
Reliance Medical Finance
If you choose the self pay option for your treatment, in the year you finance your adjustable gastric band procedure, you may be eligible to receive thousands of dollars back in potential tax savings.
IRS Publication 502 states you can deduct only your medical and dental expenses when they total more than 7.5 percent of your adjusted gross income (see p. 2 of publication 502). Adjusted gross income is your total income less a few very specific deductions. Medical expenses may include fees paid to doctors, payments for hospital services, prescription drug costs, physician co-pays and the cost of participating in a weight-loss program for a specific disease, including obesity.
Speak with your tax advisor or see IRS publication 502 for details.