| You have done your research on gastric bypass | | | | pertinent information to help in the pre-approval |
| surgery, and determined whether your insurance | | | | process. This correspondence should clearly identify |
| carrier will pay for the procedure. You have the CPT | | | | the date, your name, and the reason for the letter (e.g., |
| ICD-9 codes memorized, and you're on a first-name | | | | "request for preauthorization"). Your date of birth, |
| basis with the member services rep at the insurance | | | | insurance number, and group number should come |
| company. You have prepared the documentation | | | | immediately after this information, after which the body |
| required by your carrier, and the big day is finally here: | | | | of the letter should follow. |
| It's time to submit all this information with a request for | | | | Making Your Case |
| pre-approval of your gastric bypass procedure. | | | | Within the body of the letter, your doctor should again |
| Increase Your Chances of Insurance Success | | | | state your name, along with your age and gender, and |
| The checklist below can help you ensure you have | | | | the long-term medical problem for which you are |
| obtained everything needed to increase your chances | | | | requesting coverage of treatment-in this case, severe |
| of securing preauthorizing for weight loss surgery from | | | | or morbid obesity. |
| your insurance carrier: | | | | The body of the letter should also include your weight |
| 1. A letter of medical necessity from your primary care | | | | and height, and note that your body mass index (BMI) |
| physician or a medical specialist recommending you for | | | | is excessive for the criteria of obesity. In addition, your |
| weight loss surgery | | | | doctor should state clearly that if the weight problem |
| 2. Doctor's records of office visits documenting your | | | | continues, you would suffer from serious health risks, |
| history of obesity (this should include documentation | | | | resulting in a shorter life span. The following are other |
| supporting The National Institute of Health guidelines of | | | | topics that should be addressed in your request for |
| severe and morbid obesity) | | | | preauthorization: |
| 3. A well-documented list of any serious health issues, | | | | - The specific period of time you have been in your |
| such as hypertension or diabetes, considered a direct | | | | doctor's care expressly to manage your obesity. |
| result of severe or morbid obesity | | | | - Details of your active involvement in recommended |
| 4. A detailed list of any doctor-prescribed medications | | | | diet or medication remedies. Include the amount of |
| for weight loss | | | | weight lost in following these recommendations and |
| 5. Supporting documents pertaining to any | | | | show that you have suffered from continued weight |
| medically-supervised diet programs | | | | gain after trying these programs. |
| 6. Evaluation records and clearance if under the care | | | | - The current list of medical conditions directly resulting |
| of a mental health specialist or if taking | | | | from weight issues, and assurance that these issues |
| psychotherapeutic medication, such as | | | | would improve greatly upon shedding the excess |
| anti-depressants | | | | weight following gastric bypass surgery. |
| 7. Records of any tests requested by your insurance | | | | - The procedure expected to take place, the surgeon |
| company and their results | | | | expect to perform the procedure, the address and |
| Submitting Your Request | | | | telephone number of the surgeon or bariatric treatment |
| After verifying that you have gathered all required | | | | center, and the expected length of hospital stay. |
| documents, the office of your gastric bypass surgeon | | | | - A description of the surgery, including details of the |
| or your primary care physician will likely assist you in | | | | benefits you seek to gain from gastric bypass surgery. |
| submitting a request for preauthorization. You may | | | | Prior to sending the request, be sure to make copies |
| also submit the information yourself, but your request | | | | for yourself and your physician or surgeon, and attach |
| will likely be given more weight if coming from a | | | | all supporting documentation. You may also want to |
| medical practitioner. | | | | send your letter via registered or certified mail, so you |
| Along with your required documents, the letter to your | | | | can mark the date when your request was filed and |
| insurance company from your doctor will contain | | | | have proof that it was received. |