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