Insurance coverage for bariatric surgery varies. Most insurance companies that reimburse for bariatric surgery require patients meet certain selection criteria. If you are considering bariatric surgery, call your health insurance company to find out 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 – Lap Band (ICD-9 code 44.95)
    43659 – Sleeve Gastrectomy (ICD-9 code 43.89)
    43659 - Gastroenterostomy (ICD-9 code 44.38)

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 employer or health insurance company about your coverage:

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 start doing my paperwork so there is no interruption in my pay?

Questions to Ask Your Insurance Company:

Am I required to have bariatric surgery at a hospital that has been designated as a Center for Excellence by the American Society for Metabolic and Bariatric Surgery?

Will the surgery be covered if it is done at Bronson Methodist Hospital in Kalamazoo?

Do I need prior authorization to get coverage for my procedure?  If so, who contacts the insurance company to get authorization, me or the surgeon and hospital? Who do I (or the surgeon and hospital) contact to start 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 have to pay out-of-pocket for the surgery?  Is there a different out-of- pocket expense for the hospital and 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 types of tests do I need before you approve me to have Bariatric surgery? Do I have to pay for the tests myself, or will my insurance pay for them?