Many insurance companies have guidelines, requirements, and limitations regarding coverage for the treatment of obesity. Before your initial consult, please review your insurance policy. Check the “Exclusion of Coverage” section for mention of weight loss surgery or call your customer service representative to see if weight-loss surgery is a covered benefit under your plan. When you call, you may be asked for procedure and diagnosis codes – give them the procedure code 43770 for the Lap-Band or 43775 for the Gastric Sleeve and E66.01 for the diagnosis code. We encourage you to ask if your plan requires you to have a referral to our program or “pre-certification” of the initial appointment. If so, these must be provided through your primary care physician. Our office will arrange for the approval and pre-certification of the surgical procedure and hospital stay.
Other Questions to Ask Your Insurance:
- Is Dr. Sidney P. Rohrscheib a provider in my insurance plan?
- Ask if any of the following facilities are in my insurance plan network: Olympian Surgical Suites (Champaign), OSF Heart of Mary (Champaign), Warner Hospital and Health Services (Clinton), and St. Mary’s (Decatur).
- Does my plan have a co-payment or any other expenses I must pay for?
- What services will my insurance not cover?
You will meet with the surgeon, Dr. Sidney Rohrscheib, for your first consult. He will discuss weight loss surgery options with you in detail and the risks and benefits associated. We encourage you to bring along a family member or other support person; they can help you remember all the information you will receive at this appointment. After meeting with the surgeon, a member of our staff will discuss with you what to expect from this point on, what additional steps are needed to gain insurance approval, and answer any other questions you may have. It will be determined at your initial consult whether or not you are a candidate for surgery.
Illinois Bariatric Center requires that all patients receive a psychiatric evaluation, nutritional consult, and general medical physical prior to seeking approval for surgery. If you are determined a candidate for surgery, these appointments will be arranged through our office.
One purpose of the evaluation is to rule out glandular (endocrine) and psychiatric disorders as the major causes of severe obesity. Evaluations will also help identify those rare medical problems, which may make the risk of major abdominal surgery under general anesthesia too high. Usually, obesity-related medical problems are a reason to perform surgery for clinically severe obesity. Reasons not to perform gastric reduction surgery include the presence of active peptic ulcer disease or advanced heart, lung, and/or kidney disease.