Question:
Does anyone happen to know the Diagnostic and Procedure codes for RNY?
Hi all, I'm considering enrolling in Traditional BC/BS, but in order to find out if WLS is covered I need to get the diagnostic and procudure codes. So if any of you have an insurance statement or something from the hospital with that info on it...I'd greatly appreciate it!!! Thanks!! ~Erin — Erin D. (posted on December 16, 2002)
December 15, 2002
According to my insurance approval letter the CPT code is 43846.
— Marcy S.
December 16, 2002
My doctor (Dr. Naaman) has this posted on his website (www.drnaaman.com). I
have bcbs ppo of tx.
From website:
DOES MY INSURANCE COVER THIS PROCEDURE?
Most insurances do cover obesity procedures. The first step is to contact
your insurance carrier (the phone # is usually on the front of your card)
and give them the procedure code # CPT 43846, along with diagnosis which is
morbid obesity (ICD-9 #278.01). Be sure to get the first name and last
initial of the person you spoke with. They will give you the requirements
to meet their "medical necessity". The average insurance company
requires documentation of at least two failed medically supervised diets.
This includes letters from the supervising physicians and their medical
records.
— Jessie D.
December 16, 2002
My doctor (Dr. Naaman) has this posted on his website
(http://www.drnaaman.com/gsbypass.htm). I have bcbs ppo of tx.
From website:
DOES MY INSURANCE COVER THIS PROCEDURE?
Most insurances do cover obesity procedures. The first step is to contact
your insurance carrier (the phone # is usually on the front of your card)
and give them the procedure code # CPT 43846, along with diagnosis which is
morbid obesity (ICD-9 #278.01). Be sure to get the first name and last
initial of the person you spoke with. They will give you the requirements
to meet their "medical necessity". The average insurance company
requires documentation of at least two failed medically supervised diets.
This includes letters from the supervising physicians and their medical
records.
— Jessie D.
December 16, 2002
My doctor (Dr. Naaman) has this posted on his website
(http://www.drnaaman.com/gsbypass.htm). I have bcbs ppo of tx.
From website:
DOES MY INSURANCE COVER THIS PROCEDURE?
Most insurances do cover obesity procedures. The first step is to contact
your insurance carrier (the phone # is usually on the front of your card)
and give them the procedure code # CPT 43846, along with diagnosis which is
morbid obesity (ICD-9 #278.01). Be sure to get the first name and last
initial of the person you spoke with. They will give you the requirements
to meet their "medical necessity". The average insurance company
requires documentation of at least two failed medically supervised diets.
This includes letters from the supervising physicians and their medical
records.
— Jessie D.
December 16, 2002
sorry about all the posts - there was a glitch and then.. viola... three
posts (I admit, I probably did them all.) Sorry about that. J
— Jessie D.
December 16, 2002
I have to add to what Jessie said. Don't take what any insurance company
tells you over the phone as fact. My insurance company customer service
person said that the surgery was not covered. Granted, WLS is listed in
the 'exclusions' part of the policy. But, it is covered if you meet
certain conditions. When I was told that it was not covered, I asked to
see it in writing. They mailed me a copy of the page where it showed what
the criteria were to get the surgery approved. My insurance paid (and paid
and paid, see my profile for details).
— garw
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