Insurance coverage for bariatric surgery varies. Most insurance companies that reimburse for bariatric surgery require patients to meet certain selection criteria. If you are considering bariatric surgery, call your health insurance company to learn more about your benefits.

The insurance company may ask you for diagnosis and procedure codes to confirm coverage. Bronson uses the following codes:

Primary diagnosis code of 278.01 – morbid obesity

Procedure codes:
43644 – Gastric Bypass (ICD-9 code 44.38
43770 – Laparoscopic Adjustable Band (ICD-9 code 44.95)
43775 – Sleeve Gastrectomy (ICD-9 code 43.89)

If you do not have health insurance, or if your insurance plan does not cover bariatric surgery, Bronson has a self-pay option. Feel free to contact (269) 341-6120 to discuss the self-pay option.

Questions to Ask Your (or Your Spouse’s) Employer
Is bariatric surgery covered through my benefit package?

Can I have money deducted from my check to be placed in a health care spending account to help cover my out-of-pocket expenses?

Do I have short-term disability coverage? If so, how much pay will I receive while recovering from surgery? How long do my benefits last? When should I begin my paperwork so there is no interruption in my pay?

Questions to Ask Your Insurance Company
Am I required to have surgery at a hospital designated as a Center for Excellence by the American Society for Metabolic and Bariatric Surgery?

Is the surgery covered if done at Bronson Methodist Hospital in Kalamazoo?

Do I need prior authorization from my insurance company to get coverage? If so, who contacts the insurance company for authorization; me, the surgeon or the hospital? Who do I (or the surgeon or hospital) contact to begin the authorization process? What phone number do I call (or give the hospital and surgeon to call)?

Do I need to get a second opinion before I can have surgery?

How much will I pay out-of-pocket for surgery?  Is there a different out-of- pocket expense for the hospital and for the surgeon? Is there a maximum out-of-pocket expense? 

Am I required to participate in weight loss efforts or an exercise program? For how long? Am I required to participate in support groups or go to counseling before I can have the procedure? For how long? Are any of these requirements covered by my insurance? Do I need evidence of participation? If so, what evidence do I need?

What tests do I need before the insurance company approves me to have bariatric surgery? Do I have to pay for the tests myself, or will my insurance pay for them?