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Affordable Health Insurance Texas Article

Gastric Bypass Surgery - Keys to Obtaining Insurance Coverage

Craig Thompson

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.

About the author:

Craig Thompson, was one of the earliest to have

href="http://www.renewedreflections.com">Gastric Bypass

Surgery, in 1997. Now writes about

href="http://www.renewedreflections.com/news/insurance-coverage/"

>gastric bypass insurance

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