Rocky Mountain Associated Physicians Weight Loss Surgery Requirements
Attend a free Weight Loss Surgery Seminar.
Complete the New Patient Forms. Drop off, mail, e-mail, or fax completed forms back to us. You will receive a confirmation e-mail with information about the next steps by mail or e-mail within 5-7 business days.
We will contact your insurance company to determine if you have a weight loss surgery benefit available through your health insurance plan. We will gather any documentation and/or tests that your insurance company may require prior to surgery.
If you’d like to contact your insurance company to discuss coverage, you may need to provide them with the following procedure and diagnosis codes to receive the most accurate information:
- Roux-en-Y gastric bypass: CPT 43644
- Gastric banding: CPT 43770
- Sleeve gastrectomy: CPT 43775
- Duodenal switch: CPT 43845
- The diagnosis code for obesity is ICD 10 code E66.01
If you plan to pay for weight loss surgery without using insurance, please proceed to “Step Five.”
Obtain all medical record documentation as required by your insurance. Below are possible items or “Criteria” that your insurance company may have you complete before giving you a preauthorization for surgery:
- Nutrition evaluation
- Psychological evaluation
- 3 or 6 months medical weight loss program supervised by physician or dietitian
- Referral from primary care doctor giving clearance for surgery
Our team can help you fulfill these requirements or connect you with an experienced provider. This information will be provided in the letter or e-mail you receive from our office.
Once you have met criteria through your insurance, or are going through self-pay options you will have a consultation with the surgeon and attend an informed consent. You will be advised when to schedule these appointments.
We will prepare and submit your application, medical records and a letter of medical necessity to your insurance company for written approval.
Authorization may take 1-2 weeks depending on your insurance.
These important steps will ensure that you are well prepared for surgery. We are happy to assist you as you take the next step toward a healthier lifestyle.
Self Pay Patients:
If your employer has not elected to cover weight loss surgery, contact the human resource department of your employer and ask if there are other insurance policies offered that cover weight loss surgery. If not, encourage them to seek coverage for this growing need.
RMAP is working to promote coverage with most of the major insurers in Utah. We have been instrumental in getting SelectHealth and PEHP to begin offering this benefit to some of their policy holders as a pilot program.
Coverage for Weight Loss Surgery
Due to the recent announcement from the American Medical Association, categorizing Obesity as a disease, we are seeing more insurance companies cover weight loss surgery. However, there are still those companies which consider it as an elective surgery, and will not cover the procedure. If this is your situation, contact the human resource department of your employer and ask if there are other insurance policies offered that cover weight loss surgery. If not, encourage them to seek coverage for this growing need.
Get all the necessary forms listed above by clicking on the appropriate link below: