Step 1: Verify Your Benefits
Call the member services number on the back of the card. The primary diagnosis code for morbid obesity is 278.01. Other important weight loss surgery codes:
- 43644 – Gastric Bypass
- 43770 – Adjustable Gastric Banding
- 43775 – Vertical Sleeve Gastrectomy (VSG)
- 43845 – Biliopancreatic Diversion with Duodenal Switch
- 43860 – Revision
Step 2: Bring a Referral
Make the appropriate arrangements with your primary care physician. Please call our offices ahead of time to ensure that the referral has been received.
Step 3: Attend One of Our Weight Loss Group Seminars
Next, sign up for a free weight loss group seminar by calling 210-953-7047.
Step 4: Attend a One-On-One Meeting With Your Surgeon
During your one-on-one meeting with your surgeon, you’ll have the opportunity to discuss specific strategies for addressing your weight loss. Surgical weight loss and medical weight loss strategies may both be topics of discussion, depending on your condition.
Prior to attending this consultation, we require that you provide health history information. Most patients with obesity have other health conditions that should be addressed at this point.
During your consultation, your surgeon may recommend a surgical procedure. Afterwards, this weight loss surgery may be submitted to your insurance company. Approval may take four to six weeks, at which point we will contact you.
Step 5: Provide Medical Records & Supporting Information
Depending on your insurance, health conditions, and type of surgery requested, you will have to provide certain medical records and supporting information. Standard patient requirements include:
- Letter of medical necessity from primary care physician
- Psychological evaluation (including MMPI)
- Documentation of previous weight loss attempts
- Cardiac clearance (patients over 50 and as determined by insurance company or surgeon)
- Pulmonary clearance (patients over 50 with a BMI over 50, and as determined by insurance company or surgeon)
Your insurance company may require the following information:
- Medical records documenting weight history for a period of one to five years, depending on your health plan.
- Dietary consult
- Medically supervised diet and exercise program:
- 3-, 6- or 12-month diet requirement
- Must be consecutive and completed within the last two years.
- Miscellaneous labs (i.e. – TSH, H. Pylori, drug and alcohol screening, A1C, tobacco use, etc.)
Step 6: Attend One of Our Educational Bariatric Classes
Once your consultation with your surgeon is complete, you will be required to attend an introductory class on the surgery procedure you have applied for. This class will cover your new diet, risks, benefits, and other related information.
Once the surgery has been authorized by the insurance company, you will take a final preoperative class approximately two weeks prior to the date of your surgery. At this point, you are almost ready to make one of the biggest changes of your life!