Gastric Bypass Surgery Requesting Insurance Pre Approval

31/01/2012 Comments Off

You have completed your analysis on gastric bypass surgery, and determined regardless of whether your insurance carrier will spend for the process. You have the CPT/ICD-9 codes memorized, and you’re on a initial-name basis with the member services rep at the insurance business. You have ready the documentation needed by your carrier, and the large day is lastly right here: It’s time to submit all this details with a request for pre-approval of your gastric bypass process.

Enhance Your Probabilities of Insurance Good results The checklist beneath can aid you guarantee you have obtained almost everything required to Enhance your Probabilities of securing preauthorizing for weight loss surgery from your insurance carrier:

1. A letter of medical necessity from your main care Medical doctor or a medical specialist recommending you for weight loss surgery 2. Medical doctor’s records of workplace visits documenting your history of obesity (this really should incorporate documentation supporting The National Institute of Wellness recommendations of serious and morbid obesity) three. A well-documented list of any severe Wellness troubles, including hypertension or diabetes, deemed a direct result of serious or morbid obesity 4. A detailed list of any Medical doctor-prescribed medicines for weight loss five. Supporting documents pertaining to any medically-supervised diet plan programs 6. Evaluation records and clearance if below the care of a mental Well being specialist or if taking psychotherapeutic medication, which includes anti-depressants 7. Records of any tests requested by your insurance organization and their outcomes

Submitting Your Request Following verifying that you have gathered all needed documents, the workplace of your gastric bypass surgeon or your main care Medical doctor will most likely aid you in submitting a request for preauthorization. You might also submit the details your self, but your request will most likely be given much more weight if coming from a medical practitioner.

Along with your necessary documents, the letter to your insurance corporation from your Physician will incorporate pertinent data to support in the pre-approval procedure. This correspondence really should clearly determine the date, your name, and the cause for the letter (e.g., “request for preauthorization”). Your date of birth, insurance number, and group number must come quickly Following this data, Right after which the body of the letter must follow. Generating Your Case Inside the body of the letter, your Physician really should once again state your name, along with your age and gender, and the long-term medical dilemma for which you are requesting coverage of remedy—in this case, serious or morbid obesity.

The body of the letter really should also incorporate your weight and height, and note that your body mass index (BMI) is excessive for the criteria of obesity. In addition, your Medical doctor must state clearly that if the weight difficulty continues, you would suffer from severe Well being risks, resulting in a shorter life span. The Right after are other topics that ought to be addressed in your request for preauthorization:

• The particular period of time you have been in your Medical doctor’s care expressly to manage your obesity. • Info of your active involvement in suggested diet plan or medication remedies. Contain the quantity of weight lost in Soon after these guidelines and show that you have suffered from continued weight gain Soon after attempting these programs. • The present list of medical circumstances directly resulting from weight troubles, and assurance that these concerns would Enhance significantly upon shedding the excess weight Right after gastric bypass surgery. • The process expected to take place, the surgeon expect to carry out the process, the address and telephone number of the surgeon or bariatric therapy center, and the expected length of hospital remain. • A description of the surgery, which includes info of the advantages you seek to gain from gastric bypass surgery.

Prior to sending the request, be certain to make copies for your self and your Medical doctor or surgeon, and attach all supporting documentation. You might also want to send your letter through registered or certified mail, so you can mark the date when your request was filed and have proof that it was received.