Insurance Process

It is important to check with your insurance company prior to starting this process. Call the toll-free number listed on your insurance card for either benefits or customer service and ask the following questions.
  1. Ask if the procedure code is a covered benefit.

    Roux-en-Y Surgery Code 43644
    Lap BAND Surgery Code 43770
    Sleeve Gastrectomy Surgery Code 43659

    Be sure to clarify that you re asking about the procedures on the basis of medical necessity.
  2. Do you have any specific criteria that must be met to have weight loss surgery?
  3. Are my surgeons and Hays Medical Center providers under my plan?
  4. Are nutrition, physical therapy and psychological evaluations covered?
Do Not start the pre-cert or pre-authorization process or send anything to your insurance company regarding your request for surgery. The Bariatric Nurse Coordinator will handle this process after we receive all the needed information.

Not all insurance plans cover weight loss surgery. If the insurance company state that it is covered based upon medical necessity, the surgeon will write a letter to your insurance company describing why you specifically need the surgery done. If the insurance company instructs you that you have contract exclusion or that it is not a covered benefit then you will need to be able financially to cover the cost on your own. If self-payment is elected, payment is required in advance of your surgery date for this elective procedure.