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Gastric Bypass Surgery - Keys to Obtaining Insurance Coverage

Aug 17, 2007
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 Gastric Bypass Surgery, in 1997. Now writes about gastric bypass insurance
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