Gastric Bypass Surgery - Requesting Insurance Pre-Approval

You have done your research on gastric bypassAlong with your required documents, the letter to
surgery, and determined whether your insuranceyour insurance company from your doctor will contain
carrier will pay for the procedure. You have the CPTpertinent information to help in the pre-approval
ICD-9 codes memorized, and you're on a first-nameprocess. This correspondence should clearly identify
basis with the member services rep at the insurancethe date, your name, and the reason for the letter
company. You have prepared the documentation(e.g., "request for preauthorization"). Your date of
required by your carrier, and the big day is finallybirth, insurance number, and group number should
here: It's time to submit all this information with acome immediately after this information, after which
request for pre-approval of your gastric bypassthe body of the letter should follow.
procedureMaking Your Case
.Most Recommended Tips for Gastric Bypass SurgeryWithin the body of the letter, your doctor should
- Requesting Insurance Pre-Approvalagain state your name, along with your age and
 Increase Your Chances of Insurance Successgender, and the long-term medical problem for which
The checklist below can help you ensure you haveyou are requesting coverage of treatment—in this
obtained everything needed to increase your chancescase, severe or morbid obesity.
of securing preauthorizing for weight loss surgeryThe body of the letter should also include your
from your insurance carrier:weight and height, and note that your body mass
1. A letter of medical necessity from your primaryindex (BMI) is excessive for the criteria of obesity. In
care physician or a medical specialist recommendingaddition, your doctor should state clearly that if the
you for weight loss surgeryweight problem continues, you would suffer from
2. Doctor's records of office visits documenting yourserious health risks, resulting in a shorter life span.
history of obesity (this should include documentationThe following are other topics that should be
supporting The National Institute of Health guidelinesaddressed in your request for preauthorization:
of severe and morbid obesity) Most Recommended Tips for Gastric Bypass
3. A well-documented list of any serious healthSurgery - Requesting Insurance Pre-Approval
issues, such as hypertension or diabetes, considered• The specific period of time you have been in
a direct result of severe or morbid obesityyour doctor's care expressly to manage your obesity.
4. A detailed list of any doctor-prescribed• Details of your active involvement in
medications for weight lossrecommended diet or medication remedies. Include
5. Supporting documents pertaining to anythe amount of weight lost in following these
medically-supervised diet programsrecommendations and show that you have suffered
6. Evaluation records and clearance if under the carefrom continued weight gain after trying these
of a mental health specialist or if takingprograms.
psychotherapeutic medication, such as• The current list of medical conditions directly
anti-depressantsresulting from weight issues, and assurance that
7. Records of any tests requested by yourthese issues would improve greatly upon shedding
insurance company and their resultsthe excess weight following gastric bypass surgery.
Submitting Your Request• The procedure expected to take place, the
After verifying that you have gathered all requiredsurgeon expect to perform the procedure, the
documents, the office of your gastric bypassaddress and telephone number of the surgeon or
surgeon or your primary care physician will likely assistbariatric treatment center, and the expected length
you in submitting a request for preauthorization. Youof hospital stay.
may also submit the information yourself, but your• A description of the surgery, including details of
request will likely be given more weight if comingthe benefits you seek to gain from gastric bypass
from a medical practitioner.surgery.