Navigating Insurance and finance for Weight Loss Surgery
Most insurance carriers in the United States provide coverage for initial bariatric surgery and for revision bariatric surgery when this is required. However, in some parts of the world, bariatric surgery is frequently not a covered item. In the United Kingdom for example, the major private insurance carriers do not cover weight loss surgery. Most such work is done within the National Health Service (NHS). The situation is worse for revision bariatric surgery where it is rarely covered within the NHS or among private carriers. This leaves patients with weight regain or heartburn and swallowing disorders after prior weight loss surgery in a difficult position for financing a corrective revision procedure. This is a rather unfortunate situation but one which may change for the better.
If one does have health insurance coverage, it is essential to first determine if ‘bariatric surgery’ is a covered benefit. One could initiate a dialogue with the insurance member services - ask if CPT code 43775 (laparoscopic sleeve gastrectomy) or 43644 (laparoscopic Roux-en-Y gastric bypass) are covered in your insurance plan. If these are covered, there is a very good chance your coverage would also include revisional bariatric procedures. Coverage for the loop duodenal switch can be tricky as it does not have its own separate procedure (CPT) code. Your surgeon will often need to have a ‘peer-to-peer’ review with the medical director of your insurance company.