SMHC logo
MaineHealth logo

Insurance and Additional Information

Insurance Coverage
Some insurers consider weight loss surgery as elective. Although there are many that recognize that obesity increases the risk of serious health conditions, such as Hypertension, Type 2 Diabetes, sleep apnea, hypercholesterolemia.

Therefore, we must obtain insurance approval prior to scheduling your surgery.

It is important to call your insurance company to make sure that you have bariatric benefits in your plan. Many will ask you for a CPT code specific to your procedure of choice. Please see codes below:

• Laparoscopic Roux-en-Y gastric bypass: 43644

• Laparoscopic sleeve gastrectomy: 43775

While many of the costs that will be incurred during the evaluation process will be covered by your insurance, some charges may become the responsibility of the patient. Due to program certification criteria, we are unable to accept patient’s with Medicare insurance as either their primary or secondary insurance coverage.

If a patient qualifies medically for surgery, the surgeon’s office will request pre-approval for coverage of the procedure from the patient’s health insurer. When the insurance company gives their approval, they notify the surgeon’s office. In most cases a date for the operation will be scheduled during this notification. Once the surgery has been scheduled, patient’s are often asked to come into the office about a week before the procedure to obtain informed consent.

We will work with you and your insurance to make sure that you meet their requirements. Some of these requirements are:

• History of failed weight loss attempts (ie. Physician-supervised weight loss, Weight Watchers, Nutri system)

• Letter of medical necessity from PCP

• Psychological evaluation — to ensure patients have a clear understanding of the commitment to weight loss surgery and how life after surgery may impact one’s life.

• Nutrition evaluation — used to identify dietary changes and habits that need to be changed in order to ensure a successful transition after weight loss surgery.

© Southern Maine Health Care     1 Medical Center Drive     Biddeford, Maine 04005 USA     Tel: (207) 283-7000

SMHC is a member of the MaineHealth System and a participant in the HealthInfoNet Health Information Exchange

+ Extranet/Staff Login