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Bariatric Surgery Insurance Information

Not all insurance benefit plans cover all health care services. It is important to contact your benefit plan representative to find out what your insurance covers and what your financial obligations are as early in the process as possible, including before your first visit. Every insurance company has different requirements for bariatric surgery and every insurance policy has varying amounts of coverage, co-pays and deductibles. It is important to know exactly what your policy both requires and will financially cover before beginning the program.

There is a toll free telephone number located on the back of your insurance card. Please call the customer service or member services department listed on the back of your card to find out whether or not your insurance covers a particular health service or procedure you are having. If you do not have coverage for those services, you may be held responsible for a portion of or in some cases, the entire bill.

You will need the following information when you call:

  1. Your member number
  2. Diagnosis code of morbid obesity: ICD 10 E66.01
  3. Procedure code:
    1. CPT code 43775 for sleeve gastrectomy
    2. CPT code 43644 for gastric bypass

Check your IN-NETWORK coverage: An “in-network provider” is a provider that is contracted with the health insurance company to provide services to plan members. It’s important to verify Dr. Hanisee is in your network. If Dr. Hanisee is not in your network, your insurance company will not cover your visits.

Check your OUT of NETWORK coverage: An “out-of-network provider” is a provider who is not contracted with the health insurance plan. If you use an OUT of NETWORK Provider you will have a higher financial obligation and may be responsible for the entire bill.

If you require additional assistance regarding your in-network benefits, out-of-network benefits, whether your provider is in-network or out-of-network, what procedures are covered and not covered, and what procedures need to be authorized, please contact your insurance company directly.

Please note: Most insurance companies require you to have documentation of uninterrupted 3-6 months supervised medical weight management, in addition to other requirements. Your insurance information cannot be submitted for authorization until we have all documents required by the surgeon and the insurance company.

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