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Here are some of the key steps you should take to obtain insurance coverage for weight loss surgery:
CALL YOUR INSURANCE COMPANY: Ask about bariatric surgery (weight loss surgery) and if your policy has coverage for this type of service. Some policies will exclude weight loss treatment. Just because your friend with Blue Cross/Blue Shield was approved, that absolutely does not mean that your policy with Blue Cross/Blue Shield will allow it. EVERY POLICY IS DIFFERENT. Please do this prior to submitting your application!!
VISIT YOUR PRIMARY CARE PHYSICIAN: Before visiting the OSC office for your consultation, organize your medical records, including your history of dieting efforts. They will be valuable documents to have at every stage of the approval process. You should request copies of these records from physicians who have treated you in the past 2-3 years, depending on the specific requirements of your insurance company. These physicians also should be asked to write a letter of support for this procedure. All of this documentation is necessary for precertification with your insurance.
MEET WITH THE OSC BARIATRIC COORDINATOR AND SURGEON: If it is determined that you are a candidate for surgery and that you have sufficient documentation, we will do the rest. First, we prepare a letter to obtain pre-authorization from your insurance company. The goal of this letter is to establish the “medical necessity” of weight loss surgery and gain approval for the procedure. The following information is generally included in the pre-authorization letter and you should bring these things with you to your first office visit.
- Your height, weight and Body Mass Index and any documentation you might have as to how long you have been overweight.
- Simply describing your condition as “morbid obesity” is not enough. A full description of all your obesity-related health conditions, including records of treatment, a history of medications taken and documentation of the effects these conditions have had on your everyday life is necessary.
- A detailed history of the results of your dieting efforts, including medically and non-medically supervised programs, records of meetings attended with commercial weight loss programs.
- A letter from your general physician(s) stating that he or she believes that you are a candidate for bariatric surgery and that you have the diagnosis of morbid obesity. It is also very important for your physician to state that he/she has supervised you in diet/exercise attempts that have not helped significantly.