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:
A letter of medical necessity from your primary care physician or a medical specialist recommending you for weight loss surgery
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)
A well-documented list of any serious health issues, such as hypertension or diabetes, considered a direct result of severe or morbid obesity
A detailed list of any doctor-prescribed medications for weight loss
Supporting documents pertaining to any medically-supervised diet programs
Evaluation records and clearance if under the care of a mental health specialist or if taking psychotherapeutic medication, such as anti-depressants
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.
Depending on the type of major medical insurance policy you have, most insurance companies will pay for gastric bypass surgery (also called bariatric surgery) if you meet certain conditions. However, some insurance companies have exclusion clauses for treating obesity. These companies refuse to cover any treatment related to ?losing weight.? They will, however, treat the diseases caused by excessive body weight. How do I qualify for coverage?
To qualify for coverage, gastric bypass surgery must be considered a medical necessity. The insurance company will make the final determination. They may rely on the information your doctor sends to them or they may require you to be seen by a doctor that they specify.
In either case, certain conditions must exist. Your weight problem must present a serious risk to your life. Don't be surprised if they require a complete psychological evaluation in addition to your medical records. It is no secret that people eat too much of the wrong kinds of food for many reasons. While genetics and metabolic rate do affect how much a person weighs, often the primary causes of obesity are emotional and psychological. Gastric bypass surgery will not fix these emotional and psychological problems. In fact, if these issues are not dealt with prior to or along with the surgery, the patient may be more likely to experience serious complications. For this reason, all insurance companies require both a medical and psychological clearance before they will approve the surgery.
Remember, insurance companies are businesses. If they think you are a good candidate to maintain the weight loss permanently and that the $25,000 to $50,000 dollar price tag for gastric bypass surgery now will save them money in the long run by eliminating payment for other weight related medical problems, they will most likely cover the surgery.
How much will my insurance carrier cover?
If you are approved for gastric bypass surgery, your insurance company will pay anywhere from 50 to 100 percent of the hospital and doctor fees. Some policies will even cover in-home nursing care after release from the hospital if it is deemed necessary by the doctors and approved by the insurance company.
Several different expenses typically are associated with gastric bypass surgery, such as testing to determine eligibility for gastric bypass surgery, pre-admission testing, in-hospital costs, surgeon and other doctor fees, and post-surgery medication and care. Even if your insurance company will not cover the actual procedure, they may cover one or more of the other costs related to your gastric bypass surgery.
How can I make up the difference?
Your surgical center should be able to help you determine what will and will not be covered by your specific policy. In addition, many surgical centers offer low-interest, long-term loans if you are not approved by the insurance company, do not have medical insurance, or have high co-payments.
Since 2000, the total cost of all medically necessary weight loss treatment has been considered a deductible medical expense for income tax purposes. Those tax deductions can help you pay for at least part of the cost of your gastric bypass surgery or help you get back your co-payment for the surgery. Under the Internal Revenue code, treatment for weight loss includes behavioral counseling, nutritional counseling, prescriptions, and gastric bypass surgery if they are undertaken to treat or prevent specific diseases caused by excessive body weight.
This article provides an overview of health issues related to gastric bypass surgery and is not intended to replace the advice of a medical practitioner. Please consult your doctor prior to making any major medical decisions.
Both Anil Kumar Pammidimukkala & Craig Thompson are contributors for EditorialToday. The above articles have been edited for relevancy and timeliness. All write-ups, reviews, tips and guides published by EditorialToday.com and its partners or affiliates are for informational purposes only. They should not be used for any legal or any other type of advice. We do not endorse any author, contributor, writer or article posted by our team.
Anil Kumar Pammidimukkala has sinced written about articles on various topics from Gastric Bypass, Games and Computers and The Internet. More Details about here. Craig Thompson,better known as "Big T," has a reputation for do. Anil Kumar Pammidimukkala's top article generates over 1900 views. to your Favourites.
Craig Thompson has sinced written about articles on various topics from Gastric Bypass, Aquarium Fish. Craig Thompson, better known as "Big T," a former sumo wrestler who used to tip the scales at 400 pounds has since reinvented himself as a singer and bandleader. As one of the earliest to have. Craig Thompson's top article generates over 33100 views. to your Favourites.