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How do I know if my insurance covers either the gastric bypass or gastric band procedure?
Most insurance policies (about two-thirds) will cover weight loss surgery.  The only way to know for certain is to call the phone number on the back of your insurance card and ask this question.  We reccomend addressing the following questions:

  1. Name of Representative you are speaking to
  2. Does your plan cover weight loss (bariatric) surgery for Morbid Obesity (ICD-9 Code: 278.01)
  3. Does the plan cover Roux-en-Y Gastric Bypass (CPT Code: 43644)?
  4. Does the plan cover Laparoscopic Gastric Band Placement (CPT Code: 43770)?
  5. Are you required to get prior authorization for weight loss surgery?
  6. What criteria must be met in order to be approved?
  7. What is the weight or BMI requirement?
  8. How many months of documented weight loss history is required?
  9. Does the weight loss attempt have to be within the last 12 months, 2 years, 4 years, etc.)?
  10. What type of weight loss history is accepted (Weight Watchers, Weight Loss Clinic, PCP supervised diets & weights, insurance weight loss program etc.)?
  11. Is a Psychological Evaluation required, if so do you need prior authorization?
  12. Do you need a Letter of Medical Necessity from your Primary Care Physician?
  13. Is pulmonary clearance required, if so do you need prior authorization?
  14. Is cardiac clearance required, if so do you need prior authorization?
  15. Is a Sleep Study required, if so do you need prior authorization?
  16. Is a letter of Favorable Decision required from Social Security Administration (usually only for Medicare plans)?
  17. What other items are required
  18. Is there a time frame requirement. Example: if you had a Psychological Evaluation 14 months ago, can you use that to submit for approval now or does it have to be within a year?

Do you offer financing for the lap-band procedure?
WSUPG Bariatrics does not offer financing directly - however, we do work with several companies that do provide financing for surgical procedures.  We have provided a list of these companies on our Financing Page.

Is the cost of the gastric band procedure tax deductible?
The $11,700 (and the cost of additional band fills) may be tax deductible, if it is more than 7.5% of your adjusted income.  You can learn more about it here.

Are gastric band adjustments (fills) covered by my insurance company?
Most of the time they are covered if the insurance company authorized the original procedure.  This is an important question to have an answer to before moving forward.  For our self-pay patients, the first fill is included in the price of the procedure, each additional fill is $150.  Most patients require between 3-8 fills to reach the point of optimal adjustment.

Will you fill bands placed by other surgeons or outside the country (ie Mexico)?
We are happy to perform adjustments on any patient who has had their band placed by a certified surgeon in the United States.  The cost for self-payment adjustments is $300 per adjustment if it was not placed by a WSUPG Bariatrics surgeon.  We do not perform band adjustments on patient who had their band placed in Mexico.

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