Originally Posted by cnvh

Well, I know my insurance doesn't cover weight management issues, or surgical procedures for weight reduction-- UNLESS the patient is morbidly obese (i.e., BMI over 40) and the treatment is deemed medically necessary. Don't just go by your insurance's patient handbook-- call the insurance company and ask them if they cover procedure code 43846 (roux-en-Y gastric bypass), "if deemed medically necessary by the doctor." (Important that you include the "medically necessary" part!)

I did this, and the insurance company said that, yes, they do cover it, provided the doctor includes the proper certification codes-- I presume that means documenting what particular comorbidities you have, verifying your BMI as over 40, etc., etc. (I asked what these codes might be, but the insurance company wouldn't tell me-- I guess they think that would make it way too easy for patients to go through the process-- god forbid that it shouldn't be a headache!)

Don't be surprised if they truly do NOT cover the procedure, though... some insurance companies simply DON'T, and my understanding is that, at least for now, it is within their rights to not do so. (That could vary by state-- I'm not sure.)