Steps to Weight Loss Surgery

Step 2: Verify Insurance Coverage

Consult your insurance provider to verify your bariatric weight loss surgery benefits. Please call the phone number listed on the back of your insurance card.

When you speak to your insurance representative, please do the following:

• Write down their full name and direct extension in case you are disconnected.
• Ask about your immediate financial responsibilities, such as specialty office copays and required benefit deductibles.
• Refer to these codes to check if they cover these surgical procedures:
• Roux-en-Y gastric bypass: CPT 43644
• Sleeve gastrectomy: CPT 43775

Every insurer has different requirements to complete prior to surgery. The mandatory requirements may include:

1. Primary Care Letter of Support – most insurance providers require your Primary Care Provider (PCP) to provide us with a letter. The doctor states you are a qualified candidate for weight loss surgery based on several factors. Your healthcare professional may want to refer to our example letter of support here.
2. Medical Records – obtain relevant medical records and history from your PCP.
   1. We will need one note per year documenting height, weight and comorbid conditions for the past two to five years, depending on your insurance.
   2. Please also supply any pertinent health completed during this timeframe for our surgeons to review screenings (i.e., sleep study or cardiac work-up).
3. Diet and Exercise Program – some insurers require you to participate or show proof of participation in a supervised diet and exercise program. Your record will validate prior weight loss attempts. If you still need to complete this requirement, don’t worry. Our comprehensive program has additional resources for you.

Step 3: Initial New Patient Appointment

Once Steps 1 and 2 are completed, you’ll be contacted by our bariatric surgery coordination team member. They’ll schedule your new patient appointment with one of our bariatric surgeons.

If you’ve completed Step 1 and have not been contacted by us within two business days, please call (910) 615-BARI to speak to a representative.

During the surgeon visit, your care team will:

• Review your medical history, including annual screenings and lab tests
• Offer nutrition counseling, discuss food journaling and review your current eating habits
• Discuss your personalized plan based on your unique situation, including:
  • Current BMI
  • Weight loss goals
  • Medical comorbidities
  • Past and present weight loss attempts
• Schedule any follow-up appointments and necessary labs

Step 4: Complete Presurgery Appointments

• Psychologist consultation - You will visit with a member of our Cape Fear Valley Community Health Psychology team. This visit helps determine if you’re emotionally prepared to make lifelong lifestyle changes. We identify potential obstacles to weight loss and ensure you have a good foundation of continued support.
• Nutritionist consultation – you’ll visit with a dietitian to discuss required pre- and postsurgical diets, review your eating habits and food journal and discuss the lifestyle changes you’ll make.
• Additional specialist appointments as required.
• Support group attendance – most studies indicate that having a robust support system including medical professionals and peers leads to better long-term results. Our program highly encourages participation in a minimum of one support group meeting – before and after surgery. Click here to go to Support Group.

Step 5: Scheduling Surgery

If you’re a surgical candidate who has completed the program and insurance requirements, we’ll submit the records to your insurance company for final approval.

• You will have one Presurgical Provider visit with your surgeon. During the appointment, we’ll verify completion of the necessary steps, discuss the surgery day, review the presurgery requirements and answer any questions you have prior to surgery.
• Once approved, an appointment with a bariatric surgeon will be scheduled for a consultation and surgery date. We’ll also verify arrangements have been established for any remaining balances and payments.
• Following surgery, you’ll have several post-op visits.
  • 1 Week Post-op
  • 4 Weeks Post-op
  • 3 Months Post-op
  • 6 Months Post-op
  • Annual visits are required
• Attending support group meetings consistently following your surgery will lead to your best results.