Billing and Insurance

During your initial Consultation, Dr. Feng’s office staff with discuss the Surgery fees and help you with Insurance Pre-Authorization.

Office Phone: (650) 853-6600 (mention that you found us on our web site)

Patients should be aware that there are sometimes out-of-pocket expenses, and insurance policies may cover one type of weight loss surgery and not another type of surgery. The patient expenses can vary and the patient is ultimately responsible for those expenses. Patients should contact their insurance company to confirm their policy benefits for weight loss surgery.

Call the customer service number on the back of your insurance card. Ask if your personal policy covers the Surgical Treatment for Morbid Obesity which has the diagnosis code 278.01. If they do, ask your insurance company to send you the Medical Policies for this treatment so that you can bring in a copy to show us what your specific plan covers. This will greatly expedite getting pre-authorization for your procedure.

If you want to know whether or not your plan covers a specific procedure, ask the Customer Service representative about the one you are interested in and give the representative the procedure code to look up:

• Laparoscopic adjustable gastric banding (LAP-BAND® System or REALIZE™ Band) – CPT Code 43770
  
• Laparoscopic Roux-en-Y Gastric Bypass – CPT Code 43644
  
• Laparoscopic Restrictive Vertical Sleeve Gastrectomy – CPT Code 43843
  
• Duodenal Switch – CPT Code 43845
  
• Revision Bariatric Surgery – CPT Code 43848
  

It’s best to ask the insurance company about which surgeries are covered by your personal benefit plan before you even call (650) 853-6600 to schedule a consultation appointment so you know your options. Some employers do not purchase health insurance policies that include Bariatric Surgery, and some policies do not include the Laparoscopic Restrictive Vertical Sleeve Gastrectomy, or Sleeve Gastrectomy, at this point in time. Policies differ even among members of the same Health Insurance Company.

We do have Self Pay options for those patients who do not wish or cannot use Health Insurance to pay for Bariatric Surgery. Please ask the Bariatric Coordinator about these plans.

NOTE: Many practices charge program fees above and beyond insurance payment deductibles and copayments. Our program does not charge such extra Program fees.

Common Questions Regarding Insurance and Paying for Weight Loss Surgery

How can they deny insurance payment for a life-threatening disease?

Payment may be denied because there may be a specific exclusion in your policy for obesity surgery or "treatment of obesity." Such exclusion can often be appealed when the surgical treatment is recommended by your surgeon or referring physician as the best therapy to relieve life-threatening obesity-related health conditions, which usually are covered.

Insurance payment may also be denied for lack of "medical necessity." A therapy is deemed to be medically necessary when it is needed to treat a serious or life-threatening condition. In the case of morbid obesity, alternative treatments - such as dieting, exercise, behavior modification, and some medications - are considered to be available. Medical necessity denials usually hinge on the insurance company's request for some form of documentation, such as 1 to 5 years of physician-supervised dieting or a psychiatric evaluation, illustrating that you have tried unsuccessfully to lose weight by other methods.

Paying for Your Weight Loss Surgery

At some point, after you have spent a considerable amount of time exploring the option of weight loss surgery, you will need to determine how to pay for the procedure. A growing number of states have passed legislation that requires insurance companies to provide benefits for weight loss surgery for patients that meet the National Institutes of Health surgical criteria. And while insurance coverage for weight loss surgery is widespread, it often requires a lengthy and complicated approval process. The best chance for obtaining approval for insurance coverage comes from working together with your surgeon and other experts.

The Appeals Process

Even if your initial request for pre-authorization is not approved, you still have options available. Insurers provide an appeal process that allows you to address each specific reason they have given for denying your request. It is important that you reply quickly. It is also recommended that, at this point, you enlist the help of an experienced insurance attorney or insurance advocate to properly navigate the complexities of the appeal process. Some insurers place limits on the number of appeals you may make, so it is important to be well prepared and that you clearly understand the appeal rules of your specific plan.

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