Billing and Insurance drponce
Understanding Insurance Coverage
The best chance for obtaining approval for insurance coverage for your bariatric surgery is by working together with your surgeon and other allies to prepare a complete, detailed and documented packet of necessity to submit to the insurance company the first time. Getting insurance coverage for your surgery is a battle that in many cases you can win. Realize this may be the battle of your life, but one that is worth the fight. Don’t submit without the proper allies, strategies and tools for success. We will help guide you through the time-tested steps to success. Basically you need the following:
Is it covered?
1. First check if your insurance company covers “Weight loss surgery.”
2. Ask your Primary Care Physician to refer you for bariatric surgery establishing “MEDICAL NECESSITY”: Your physician should explain that you are 100 pounds or more above your ideal weight or that you have a BMI more than 40 or more than 35 with associated medical problems, have been over weight for more than five years, have tried to lose weight several times unsuccessfully, and he/she advises weight loss is medically necessary. In addition your physician should describe ALL your medical problems associated with being overweight (high blood pressure, diabetes, sleep apnea and arthropathy) if you have them. Call our office for an example letter.
Document your attempts
3. Document your weight loss history for the past five years from the beginning and list every commercial (Weight Watchers, Jenny Craig, etc.) and medically supervised weight loss effort you can remember, up to and including any current efforts. If you’ve had prior physician weight loss attempts, get copies of your medical records.
Make an appointment
4. Make and appointment with one of our Bariatric Surgeons. We will submit all the information to your insurance Company. If your surgery is approved, we will need to request a copy of your prior authorization in writing. If it is not approved you may need to APPEAL. Our insurance coordinator will provide you with an appeal process guide to aid you through this step of the insurance guidelines.
Getting insurance coverage is not always easy, but you’re not alone. Our staff works hard to do everything in order to gain insurance approval for this procedure. You are your best champion, and we are on your side.