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Gastric Bypass Surgery - Requesting Insurance Pre-Approval

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




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