Gastric Bypass Surgery – Requesting Insurance Pre-Approval
You have done your analysis on gastric bypass surgery, and determined whether or not your insurance carrier can procure the procedure. You have got 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 ready the documentation required by your carrier, and the massive day is finally here: It’s time to submit all this data with a call for participation for pre-approval of your gastric bypass procedure.
Increase Your Possibilities of Insurance Success
The checklist below can facilitate your guarantee you have obtained everything required to increase your probabilities of securing preauthorizing for weight loss surgery from your insurance carrier:
1. A letter of medical necessity from your primary care physician or a medical specialist recommending you for weight loss surgery
2. Doctor’s records of workplace visits documenting your history of obesity (this should embrace documentation supporting The National Institute of Health guidelines of severe and morbid obesity)
3. A well-documented list of any serious health problems, like hypertension or diabetes, thought of an instantaneous result of severe or morbid obesity
4. A detailed list of any doctor-prescribed medications for weight loss
5. Supporting documents pertaining to any medically-supervised diet programs
6. Evaluation records and clearance if beneath the care of a mental health specialist or if taking psychotherapeutic medication, like anti-depressants
7. 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 possible assist you in submitting letter of invitation for preauthorization. You’ll conjointly submit the data yourself, however your request can probably be given additional weight if returning from a medical practitioner.
Along along with your needed documents, the letter to your insurance company from your doctor will contain pertinent data to help within 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 range, and group range ought to return immediately when this data, after that the body of the letter ought to follow.
Creating Your Case
At intervals the body of the letter, your doctor ought to once more state your name, along along with your age and gender, and the long-term medical problem for which you’re requesting coverage of treatment—during this case, severe or morbid obesity.
The body of the letter ought to additionally include your weight and height, and note that your body mass index (BMI) is excessive for the standards of obesity. In addition, your doctor should state clearly that if the burden downside continues, you’d suffer from serious health risks, resulting during a shorter life span. The following are other topics that ought to be addressed in your request for preauthorization:
• The specific amount of your time you have got been in your doctor’s care expressly to manage your obesity.
• Details of your active involvement in suggested diet or medication remedies. Embrace the quantity of weight lost in following these recommendations and show that you have suffered from continued weight gain when making an attempt these programs.
• The current list of medical conditions directly ensuing from weight problems, and assurance that these issues would improve greatly upon shedding the surplus weight following gastric bypass surgery.
• The procedure expected to take place, the surgeon expect to perform the procedure, the address and telephone variety of the surgeon or bariatric treatment center, and therefore the expected length of hospital stay.
• A description of the surgery, including details of the benefits you request to gain from gastric bypass surgery.
Previous to sending the request, be positive to create copies for yourself and your physician or surgeon, and fasten all supporting documentation. You’ll also need to send your letter via registered or certified mail, therefore you’ll be able to mark the date when your request was filed and have proof that it was received.
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