Gastric Bypass Surgery – Keys to Obtaining Insurance Coverage

As soon as you have decided to pursue gastric bypass surgery,
you should contact your insurance company right away to find out
whether your policy covers the procedure. You can find the
number for member services on your insurance card or on the
Website for your insurance provider. When you contact a company
representative, always be specific about the type of surgery you
are going to have–for example, laparoscopic Roux-en-Y gastric
bypass surgery–and be sure to write down the date, time of day,
and the name of the person with whom you spoke.

Additionally, make note of what the member services
representative tells you regarding your policy and the documents
you will need for preauthorization. Request that your carrier
provide you with a certificate of coverage by mail, so you can
compare this list to the terms you were given over the phone and
make sure you obtain all the necessary paperwork. Finally, be
sure to get the mailing address where you should send your
medical documentation and preauthorization request.

Planning Gastric Bypass Surgery Once you have confirmed that you
are covered by your insurance policy for weight loss surgery,
you should request a gastric bypass surgery referral from your
physician. The referral indicates that your physician supports
the procedure and believes it is medically necessary. A formal
letter of recommendation from your primary care physician is
also helpful when submitting a request for preauthorization.

You must also obtain documentation that you are a proper
candidate for gastric bypass surgery. Insurance companies have
different requirements for obtaining pre-approval, which should
be detailed in your certificate of coverage. These generally
include information regarding your body mass index (BMI) and
diagnosis of severe or morbid obesity, a documented history of
doctor-supervised diet and exercise programs, a list of weight
loss medications prescribed by your primary care physician, and
complete medical and psychiatric evaluations. In addition, you
should document any serious or life-threatening obesity-related
health issues (known as co-morbidities), such as coronary heart
disease, high blood pressure, or osteoarthritis.

Improving Your Chances for Insurance Pre-approval Be sure that
you thoroughly investigate every avenue for arranging gastric
bypass surgery and obtain all required medical records,
supporting documentation and letters of recommendation prior to
submitting a request to your insurance company for pre-approval.
It is imperative that your insurance company understands the
procedure is medically necessary and not for cosmetic reasons.
By working closely with your physician and a qualified bariatric
surgeon, you can help the lengthy and complicated
preauthorization process go smoothly and increase your chances
of having insurance pay for your procedure.

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