It is important to check with your insurance company prior to starting this process. You may contact your insurance company by calling the toll free number listed on your card for customer service. Many insurance companies have their coverage and benefit information on their web-site. Click here for a list of insurance plans we accept.
Here are a few helpful tips and questions to ask your insurance company.
Ask if the bariatric procedure code is a covered benefit.
• Roux-en-Y Surgery (Code 43644)
• Laparoscopic Gastric Banding Surgery (Code 43770)
• Laparoscopic Vertical Sleeve Gastrectomy (Code 43775)
Be sure to clarify that you are asking about the procedures on the basis of medical necessity.
What limits and/or requirements are stated in order to receive morbid obesity treatment?
• Is there a certain amount of required time you must document attempted weight loss?
• Does the documented time have to be consecutive?
• Is your physician required to document your weight loss attempts?
• Do you need to weigh a certain amount before treatment is performed and/or initiated?
• Is there an age requirement to receive care?
• Must you use a specific Center of Excellence or medical provider to receive coverage?
• Are there weight limitations preventing coverage?
Are my surgeon and Emory Decatur Hospital providers under my plan?
What testing is covered, such as nutritionist, psychologist, labs, sleep apnea study, ultrasounds, etc.?
Helpful Tips When Speaking with Your Insurance Representative:
• Speak slowly and clearly.
• Ask for their name and write it down when they answer the call (request they spell it for you if you are not sure).
• Ask for a specific phone number and/or e-mail address from the representative and write it down.
• Ask for a hardcopy of your policy to be mailed to you with the areas regarding obesity and morbid obesity highlighted.
• If you are promised or guaranteed anything regarding your policy, make sure you receive it in writing. This will provide you with documentation if you experience a claim dispute.
• Keep a detailed record of all your documents.
• Be persistent.
For your convenience, you may download our Patient Insurance Information Form. Please complete the form and fax to our office at 404.419.1680 and we will verify your insurance prior to your visit.