Gastric Bypass Surgery Requesting Insurance Pre Approval

Gastric Bypass Surgery Requesting Insurance Pre Approval



You have done your research on​ gastric bypass surgery,​ and determined whether your insurance carrier will pay for the​ procedure. you​ have the​ CPT/ICD-9 codes memorized,​ and you’re on​ a​ first-name basis with the​ member services rep at​ the​ insurance company. you​ have prepared the​ documentation required by your carrier,​ and the​ big day is​ finally here: It’s time to​ submit all this information with a​ request for pre-approval of​ your gastric bypass procedure.

Increase Your Chances of​ Insurance Success
The checklist below can help you​ ensure you​ have obtained everything needed to​ increase your chances of​ securing preauthorizing for weight loss surgery from your insurance carrier:

1. A letter of​ medical necessity from your primary care physician or​ a​ medical specialist recommending you​ for weight loss surgery
2. Doctor’s records of​ office visits documenting your history of​ obesity (this should include documentation supporting the​ National Institute of​ Health guidelines of​ severe and morbid obesity)
3. A well-documented list of​ any serious health issues,​ such as​ hypertension or​ diabetes,​ considered a​ direct result of​ severe or​ morbid obesity
4. A detailed list of​ any doctor-prescribed medications for weight loss
5. Supporting documents pertaining to​ any medically-supervised diet programs
6. Evaluation records and clearance if​ under the​ care of​ a​ mental health specialist or​ if​ taking psychotherapeutic medication,​ such as​ anti-depressants
7. Records of​ any tests requested by your insurance company and their results

Submitting Your Request
After verifying that you​ have gathered all required documents,​ the​ office of​ your gastric bypass surgeon or​ your primary care physician will likely assist you​ in​ submitting a​ request for preauthorization. you​ may also submit the​ information yourself,​ but your request will likely be given more weight if​ coming from a​ medical practitioner.

Along with your required documents,​ the​ letter to​ your insurance company from your doctor will contain pertinent information to​ help in​ the​ pre-approval process. This correspondence should clearly identify the​ date,​ your name,​ and the​ reason for the​ letter (e.g.,​ “request for preauthorization”). Your date of​ birth,​ insurance number,​ and group number should come immediately after this information,​ after which the​ body of​ the​ letter should follow.
Making Your Case
Within the​ body of​ the​ letter,​ your doctor should again state your name,​ along with your age and gender,​ and the​ long-term medical problem for which you​ are requesting coverage of​ treatment—in this case,​ severe or​ morbid obesity.

The body of​ the​ letter should also include your weight and height,​ and note that your body mass index (BMI) is​ excessive for the​ criteria of​ obesity. in​ addition,​ your doctor should state clearly that if​ the​ weight problem continues,​ you​ would suffer from serious health risks,​ resulting in​ a​ shorter life span. the​ following are other topics that should be addressed in​ your request for preauthorization:

• The specific period of​ time you​ have been in​ your doctor’s care expressly to​ manage your obesity.
• Details of​ your active involvement in​ recommended diet or​ medication remedies. Include the​ amount of​ weight lost in​ following these recommendations and show that you​ have suffered from continued weight gain after trying these programs.
• The current list of​ medical conditions directly resulting from weight issues,​ and assurance that these issues would improve greatly upon shedding the​ excess weight following gastric bypass surgery.
• The procedure expected to​ take place,​ the​ surgeon expect to​ perform the​ procedure,​ the​ address and telephone number of​ the​ surgeon or​ bariatric treatment center,​ and the​ expected length of​ hospital stay.
• A description of​ the​ surgery,​ including details of​ the​ benefits you​ seek to​ gain from gastric bypass surgery.

Prior to​ sending the​ request,​ be sure to​ make copies for yourself and your physician or​ surgeon,​ and attach all supporting documentation. you​ may also want to​ send your letter via registered or​ certified mail,​ so you​ can mark the​ date when your request was filed and have proof that it​ was received.




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