Although many health insurance companies recognize the long-term benefits of surgery for severe obesity and approve the procedure, every company uses different criteria for the approval process. For this reason we request written prior approval for the surgery from your health insurance carrier in every case. This includes written documentation of the medical indications that justify surgery. Preapproval may take as long as four to six weeks. We can help you with preauthorization, so contact us today to get started!
We work with the following insurance companies. If yours isn’t listed, please call to ask about coverage:
- Regence Blue Cross
- Pacific Source
- Oregon Health Plan
Some insurance companies require a referral or a medically documented weight loss before approving the surgery. Check your policy to determine coverage for bariatric surgery by calling the phone number on the back of your insurance card. Check your policy regarding specific requirements and inform our office of your findings. Provide your insurance company with the correct bariatric CPT code:
Gastric bypass: 43644
Sleeve gastrectomy: 43775
Once you are under our care, we’ll take over and conduct the preauthorization on your behalf.
Most insurance companies require pre-certification of your hospital stay. This is not the same as preauthorization for surgery. We are happy to obtain this pre-certification if you provide the phone number of the pre-certification company shown on your insurance card.
Please be aware of the following during the preapproval period:
- Your insurance company may require additional medical records and tests from other physicians. The letter for preauthorization will not be sent until all requested information has been received. It is your responsibility to provide our office with this information.
- Approximately four to six weeks following the mailing of the preapproval letter, call our office to check on the status of your approval process. We will call you if we receive information prior to that.
- The majority of insurance companies that cover the procedure require that a patient be at least 100 or more pounds over his or her ideal body weight as measured by the Metropolitan Life table.
- Once your insurance approves your surgery, we’ll give you information on your financial responsibility, depending on your policy, deductible, and co-pays.
- If you receive a denial letter from your insurance company, please contact our office. We can offer suggestions on ways to appeal this decision as well as pursue possible alternative financing. Don’t get discouraged; sometimes persistence pays off.
- If you do not have insurance or have contract exclusion, please contact our office for pricing information and additional charges. Payment for surgery is required prior to surgery.
- Any balance on your North Bend Medical Center account that is your responsibility must be paid prior to surgery.