Insurance Coverage for Weight Loss Surgery

Insurance coverage for weight loss surgery varies with each person and employer. Weight loss surgery is considered a special category by most insurance companies. We encourage you to contact your insurance company to find out if you are eligible for weight loss surgery.

What should I ask my provider about weight loss surgery?

Ask your insurance company if the following procedure codes (CPT code) are covered benefits:

• CPT Code 43644 laparoscopic Roux-en-Y gastric bypass
• CPT Code 43775 laparoscopic sleeve gastrectomy
• CPT Code 43770 laparoscopic adjustable gastric band

Many insurance companies require documentation of medical conditions and medical treatment by your primary care doctor in order to establish whether you meet their weight loss surgery criteria. Your primary care physician may need to generate the authorization. Some insurance companies may also require that you have one or more of the following completed in order to approve surgery:

• Bariatric psychiatric evaluation
• Primary care physician’s documentation regarding co-morbidities (obesity-related conditions such as diabetes, high blood pressure, high cholesterol, Gastroesophageal Reflux Disease (GERD), arthritis or sleep apnea)
• Primary care physician’s documentation of previous weight loss attempts

Henry Ford Hospital has a bariatric surgery insurance specialist who will work with you to obtain insurance authorization. Our insurance specialist, Ann, can be reached at (313) 916-9248.