BMI chart

A step-by-step guide to your insurance company:

First-- remember, insurance companies will take longer than you can imagine to get this approved. So patience is the first rule here. We will work with you and your insurance company. Unless you are our patient, we cannot pre determine if your insurance company will cover the benefit. When you come in for a consultation, we will work with you and your insurance company. Below is a guide to help you determine if your insurance company will cover the procedure.

We are pleased that you have chosen us for your weight loss surgery. We are committed to providing a comprehensive weight loss surgery program involving excellent surgery as well as pre and postoperative education, evaluation, and support. We strongly believe that the best results are achieved with a comprehensive program. However, we realize that high quality weight loss surgery is expensive, this is why we have worked with the hospitals and our anesthesiologists to have the best value for the LAP-BAND in Arizona. In addition, our office works hard to have your band covered by your insurance, if possible. Therefore, we will work with you to help you find a way to pay for the surgery. This may involve paying for the operation yourself, financing the cost through a finance company, or obtaining health insurance coverage for the surgery.

Though insurance coverage of the surgery is often the least expensive option for you, obtaining insurance authorization for weight loss surgery can be frustrating and time consuming. Despite the fact that weight loss surgery is endorsed by the National Institutes of Health as the only effective treatment for morbid obesity, some insurance policies do not cover it at all. Obtaining insurance authorization usually involves the following steps:

Below we will give you a step by step approach for your insurance company. But you can always make your first step an appointment with us. With a consultation we will evaluate whether you would qualify for weight loss surgery, and then you will meet with our staff. We cannot inquire of your insurance company without seeing you in our office as our patient. But prior to coming to the office there are some things you can do.

We would also encourage you to do the following steps:

1. Make an appointment to come into our office
2. We will help you with your insurance company, to find out what it requires for us to place the band.
3. We will then determine what documentation (prior chart notes from your medical doctor) are required so you meet all the criteria for coverage required by your insurance policy.
4. We will then prepare a comprehensive letter of medical necessity outlining your situation and send it to your insurance company requesting approval for your weight loss surgery.

Whenever we receive something from one of your physicians, we will email you and let you know. That way you don't have to wonder if we received chart notes, tests, etc.

At the consultation we will get precise information about your height and weight, and some are surprised by both. S. Bring your insurance card with you to your appointment.

Understand the codes for weight loss surgery:

The ICD-9 Diagnostic Code for Morbid Obesity is 278.01

The CPT Procedure Code the the band is: 43770

INSURANCE AUTHORIZATION
We recommend that you contact your insurance company to find out if weight loss surgery is a covered benefit, which procedures they will approve, and if you are allowed to select the surgeon you prefer. Use the checklist below to help you, and be sure to document below every number you call, every individual you speak with, and the time and date that you spoke with them. Bring this with you to your office appointment. Please note that sometimes Dr. Simpson may or may not be listed, as insurance companies sometimes use the corporation name.

Some patients like to check with their insurance company prior to coming to our office. For that, we have a handy way to do it below:

Step 1: Call your insurance company
Call the benefits coordinator at your human resource office and/or call the customer service line on your insurance card. State "I am inquiring about my policy benefits regarding the surgical treatment of morbid obesity. Is surgery for morbid obesity a covered benefit?" If they say yes, then ask them what CPT procedure codes they cover. The Lap Band procedure code that you would be inquiring about is CPT 43770. Don't forget to document this. Finally, ask them to send you a copy of their policy on the surgical treatment of morbid obesity (ICD 9 code 278.01).
You may use the list below to help you ask all the questions and to document the answers received.

1. Telephone number and extension called: _____________________

2. Is surgery for morbid obesity a covered benefit? Yes No

3. Which CPT codes are covered?
43770 Lap Band Yes No

4. Do you have a policy on surgery for morbid obesity that I can obtain?

5. What information do you require before authorizing the surgery?
a. Nutrition consult required? Yes No
b. Psychological consult required? Yes No
c. Medical clearance from your physician Yes No
d. Note from Surgeon Yes No
e. Documentation of weight loss attempts Yes No
f. Documentation of length of obesity Yes No

6. Ask whether you are required to see an in-plan provider or a contracted provider.This may make it more difficult for you be approved to see us, and you may need to consult an attorney. This is the most difficult problem for patients in HMOs.

7. Get the full name and direct extension of the person with whom you spoke.

Nutrition Consult: Most insurance companies require a consultation with a dietician or nutritional specialist before they will authorize your surgery. Typically, our nutritionist will see you first when you come to the office. Just call to schedule. It is important to document your past weight loss efforts in as detailed a way as possible. Certificates or receipts for weight loss programs, especially if they were medically supervised and included weight measurements, are very helpful. This includes chart notes from your Primary Care Physician's office.

Psychological Consult: Most insurance companies require a preoperative psychological consultation. Many patients already have a therapist or know of one. To expedite the scheduling of your surgery, you may see a psychologist or psychiatrist prior to your appointment with us for your psychological clearance or this can be arranged at your first office appointment. We do have a psychologist in house, who will be happy to discuss this with you.

Letter of Medical Clearance and Medical Necessity from your Primary Care Physician (If you are seeking insurance coverage): After your appointment with us we can help your primary care doctor know what they need to gather for the insurance company. For some it is a simple letter (we have samples for them) for others it is chart notes.

Be sure to ask all of the individuals you see to fax copies of the reports to our office at (602) 230-8344. It is also a good idea to obtain printed copies for your records.

Step 3: What we will do
After your appointment with, we will give you a list of things we need from you. For some patients it will be a cardiac stress test, or other tests. Once we know what your insurance company requires we will begin to gather all the information they require. We will keep you informed every step of the way. Once we have all the information together our insurance specialist will send out the request for authorization for surgery. We will always try to advise you of what your chances are of being approved. We will also try to advise you about any deductibles and co-pays. If weight loss surgery is not covered by your insurance we will help you arrange financing if you are interested.

For further information on costs and other inquiries regarding our financial policy, come in and meet with us.

Disclaimer If your BMI is in the range of 20 through 24 you are in the normal weight range. A BMI of 24 through 30 is in he overweight range. A BMI of 30, or greater, may mean your best weight loss option is the LAP-BAND, the safest weight loss surgery.

Because the adjustable laparoscopic band is much safer than gastric bypass operations, patients whose BMI is 30 or greater may be eligible for weight loss surgery.

We encourage you to check out our publications, and learn about losing weight in a safe healthy manner.

There are some things we know about insurance companies:

Tri-Care: We are the Tri-Care specialists in the Valley and have worked with them a lot. They are very easy to work with and get our patients approved.

United Health Care: Generally easy to work with and get approval. There are some policies that do not offer it, but most are fairly easy.

Blue Cross of Arizona -- now covering the band in some circumstances! Dr. Simpson has worked hard over the last few years with the medical director of Blue Cross of Arizona, and now they will cover the band. There are a number of different policies (one for each state) and we keep up to date with all of them.

Cigna -- There are a number of plans that we work with. Please check with Cigna.

AHHHCS - a number of plans cover the band, but will require some work with your primary care physician. Before you see us for a consultation you will need a referral from your primary care physician. We cannot see you without authorization from your insurance company. Note that we do not take Mercy Care for the band. .

Aetna - covers the band and has worked well with surgeons and policy holders.

Most HMO plans will require a referral to see us in consultation. Please check with your insurance company to verify whether you need a referral prior to seeing us.

No staples means the operation is safer - meaning that BMI requirements are lower for the LAP-BAND than the RNY gastric bypass or the sleeve (gastric sleeve).

Arizona's Premier LAP BAND specialist

Arizona LAP-BAND