Our surgeons and St. Mark’s hospital are in-network providers for most insurance plans. Insurance benefits and criteria for weight loss surgery can vary greatly by plan and by employer. We can help you verify benefits and criteria specific to your plan. Most insurance companies base their criteria on the NIH guidelines:
- BMI of 40 or greater
- BMI of 35-40 with a significant co-morbidity
- Documented previous weight loss attempts
- Multi-disciplinary team approach t o surgical weight loss
- Life-long medical surveillance
These requirements may apply if surgery is a covered benefit under your policy. Some policies have exclusions which would mean that your insurance plan does not cover these services.
If you need help working with your insurance provider regarding weight loss surgery, the Obesity Action offers a guide: Working with Your Insurance Provider: A Guide to Seeking Weight Loss Surgery.
It’s a good idea to familiarize yourself with the terms of your insurance coverage in order to understand how your benefits apply to the hospital’s billing procedures and charges.
You can use the following billing codes to help you find out if your insurance has a bariatric surgery or weight loss surgery benefit:
|Laparoscopic Gastric Bypass||43644|
|Open Gastric Bypass||43846|
|Gastric Banding System||43770|
|Biliopancreatic Diversion with Duodenal Switch||43845|
If you do not have a bariatric surgery benefit through your health insurance, St. Mark’s Hospital and the surgeons at Rocky Mountain Associated Physicians offer competitive flat rate package pricing. Our discounted pricing includes complication coverage for most of the weight loss surgery procedures offered at St. Mark’s Hospital. Conditions apply. Please contact our office or attend a weight loss surgery seminar for additional information.
Meeting Your Insurance Criteria:
To get a preauthorization, some insurance companies require you to have additional evaluations as your prepare for your surgical weight loss journey. Our team at the Weight Treatment Center can help you meet these requirements. Our team can help you meet your nutrition evaluation, psychological evaluation and supervised diet requirements. For specific details and pricing information call (801) 268-7479.
Documenting Your Weight Loss Attempts:
Some insurance carriers require three to six consecutive months of documented weight loss attempts within the last two years. Patients’ primary care physicians can help you complete necessary documentation, which may include:
- Vital signs (must include weight)
- Discussion of and suggestions for current dietary program
- Discussion of physical activity or exercise program and recommendations
- Discussion of behavioral modification, including successful changes made
- Discussion of or use of FDA approved pharmacotherapy, if appropriate
Please note that these are just guidelines. Specific requirements vary according to insurance plans.
We have provided a list of insurance companies that have covered weight loss surgery in the past. Since this list can change at any time, please contact your insurance plan to understand your coverage benefits with regards to surgical weight loss.
- Altius Federal
- Blue Cross of California
- Blue Cross of Idaho
- Blue Cross Federal
- Blue Cross of Wyoming
- Blue Cross (most out of state plans)
- Benefit Planners
- Deseret Mutual (DMBA)
- Eighth District Electrical
- Empire Blue Cross
- Employee Benefits Management (EBMS)
- First Health
- Great West Life