Questions to ask your insurance company about weight loss surgery

  1. Is morbid obesity a covered benefit in your policy? Give your insurance company the ICD9 code of 278.01. If morbid obesity is a covered benefit, check that the operative procedure you are considering is also covered.
    • Roux-en-Y gastric bypass: CPT 43644
    • Adjustable gastric banding: CPT 43770
    • Sleeve gastrectomy: CPT 43775
    • Duodenal switch: CPT 43645

    Finally ask if Duke Regional Hospital, Duke Raleigh Hospital, and the physicians of the Private Diagnostic Clinic at Duke University Hospital are accepted by your insurance.

  2. What percent of the total bill will you be responsible for and is there a deductible that you will need to pay?
  3. If your policy does not cover morbid obesity or the operative procedure, you have a couple of options:
    • You have the option to obtain another insurance carrier, but you need to make sure that the new policy covers morbid obesity and the surgical procedure.
    • You can continue to participate in medical programs designed to lose and maintain weight loss.
    • In selected cases we will consider performing the surgery if you elect to self-pay. There is a considerable deposit required by the hospital and you must fully understand all risks of financial burden. We will review this major decision with you extensively and will help in any way we can.

If you cannot understand the information given by your insurance company on coverage of obesity care, please feel free to contact one of our financial care counselors at 919-470-7000 for an in-depth review of your policy.

Patient manual Index