The Sanford Weight Loss Surgery Program is committed to providing our patients with the highest level of medical and surgical care, while taking into account your overall well-being. We appreciate the consideration you are giving to this life-changing process. The following information is to assist you in obtaining the maximum benefits from your insurance plan. You will work with our bariatric insurance specialist to help guide you through the pre-approval process. They will meet with you at your initial consultation to provide details on your specific insurance requirements.
Body mass index
We first ask that you calculate your body mass index (BMI) to determine if you generally qualify for bariatric or metabolic surgery. Typically, insurance requires a BMI of 35 with obesity-related health problems or a BMI of 40. Check your BMI here.
Please take our healthy weight self-assessment quiz here.
The best way to ensure you receive the benefits you are entitled to from your insurance provider is to know your insurance plan. The more you understand about your insurance coverage, the more empowered you are. Insurance companies offer varied coverage for weight loss surgery. This can depend on the individual policy and employer. If your insurance company covers weight loss surgery, please check to see that Sanford Health and our surgeons are within your plan network. There may be co-pays and deductible costs involved. It is best to know these costs beforehand. Our insurance specialist will be happy to help you navigate your insurance policy. Be sure to bring your insurance card, and if necessary, any co-payment and referrals to your appointment.
The benefits under insurance plans vary considerably and by employer. We recommend that you first contact your insurance plan by calling the phone number provided on your benefits card to inquire about coverage of weight loss surgeries. When requesting information, they may ask you for the CPT code of surgery you are pursuing (below) and diagnosis (ICD-10) code, which is E66.01.
Those numbers are as follows:
- Gastric bypass – 43644
- Lap-Band® – 43770
- Sleeve gastrectomy – 43775
With this call, your insurance plan should be able to provide you with specific information regarding the extent of your coverage for weight loss surgery.
Common insurance requirements
The insurance approval process for bariatric surgery can be challenging. We will assist you as we work together for your surgery approval. Please remember your insurance requirements for bariatric surgery will vary depending on your specific plan. Below are the most common insurance plan requirements.
- Clinical diagnosis of your medical conditions
- Documentation of professionally/medically supervised diet plans in the past three to six months
- Referral letter from primary physician may be needed
- Copies of your medical records
- A psychological evaluation
- Dietary evaluation
For more information on your insurance coverage for metabolic and bariatric surgery, use worksheet below to help determine your coverage prior to arranging a consultation. The worksheets are a tool to help you understand the general requirements for weight loss surgery. You will meet with our insurance specialist at your initial consultation to determine exactly what steps you need to take for approval.
If your insurance policy does not cover weight loss surgery, there are self-pay and financing options available. Our insurance specialist will be happy to discuss these options at your consultation appointment.
Will insurance cover my surgery?
Although weight loss surgery is endorsed by the National Institute of Health as the only effective treatment for morbid obesity, not all insurance policies cover the associated costs of bariatric surgery. Insurance companies that do not provide bariatric surgery as a benefit often require the patient to provide documentation of your health, weight history, past weight loss attempts, medical conditions related to your weight, and perhaps more. There are many different insurance companies and their policies can widely vary. When beginning to pursue surgery, it’s important to first contact your insurance provider to find out if your specific policy covers weight loss surgery.
Regional companies such as Blue Cross Blue Shield of South Dakota, Blue Cross Blue Shield of Minnesota and Sanford Health Plan offer many policies that include coverage for weight loss surgery. Please know it’s very important for you to get the information you need from your specific insurance company. Sanford’s insurance specialist will also help guide you along the way toward surgery.
How much does surgery cost?
The cost of surgery varies from patient to patient, depending on medical needs. For all payment information, including payment plans and cost estimates, please contact Sanford Patient Financial Services at (605) 328-6585 or (877) 629-2999.
What if insurance doesn’t cover my surgery?
Self-pay options are available. Please contact Sanford Surgical Associates at (605) 328-6585 or (877) 629-2999 to learn more.
You’ve thought long and hard about it and you’ve decided weight loss surgery offers your best hope in the battle against obesity. What’s your next step in this life-changing journey? Learn more about weight loss surgery and how to get started. If you are interested in attending a free informational seminar, please click here to learn more about the upcoming dates and times.
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