December 9th, 2010 
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You might have accomplished your analysis on gastric bypass surgical procedure, and decided whether or not your insurance carrier can pay for the procedure. You have the CPT/ICD-9 codes memorized, and also you’re on a first-name basis with the member providers rep at the insurance coverage company. You’ve gotten prepared the documentation required by your carrier, and the massive day is finally here: It’s time to submit all this data with a request for pre-approval of your gastric bypass procedure.
Improve Your Probabilities of Insurance Success
The guidelines beneath can help you ensure you will have obtained all the things wanted to extend your probabilities of securing preauthorizing for weight reduction surgical procedure from your insurance coverage provider:
1. A letter of medical necessity from your major care doctor or a medical specialist recommending you for weight loss surgical procedure
2. Doctor’s information of office visits documenting your history of weight problems (this could embody documentation supporting The Nationwide Institute of Health tips of extreme and morbid obesity)
3. A well-documented checklist of any critical well being points, comparable to hypertension or diabetes, thought-about a direct results of extreme or morbid weight problems
4. An in depth record of any doctor-prescribed medications for weight loss
5. Supporting paperwork pertaining to any medically-supervised eating regimen applications
6. Analysis data and clearance if beneath the care of a mental well being specialist or if taking psychotherapeutic remedy, similar to anti-depressants
7. Records of any exams requested by your insurance coverage company and their results
Submitting Your Request
After verifying that you’ve gathered all required documents, the office of your gastric bypass surgeon or your main care physician will possible help you in submitting a request for preauthorization. You might also submit the knowledge yourself, but your request will likely be given extra weight if coming from a medical practitioner.
Alongside with your required documents, the letter to your insurance coverage company out of your doctor will contain pertinent info to assist in the pre-approval process. This correspondence ought to clearly identify the date, your identify, and the reason for the letter (e.g., “request for preauthorization”). Your date of birth, insurance quantity, and group quantity ought to come instantly after this info, after which the body of the letter should follow.
Making Your Case
Inside the body of the letter, your doctor ought to again state your name, along together with your age and gender, and the lengthy-time period medical downside for which you might be requesting coverage of remedy—in this case, severe or morbid obesity.
The physique of the letter should also include your weight and height, and word that your physique mass index (BMI) is extreme for the factors of obesity. In addition, your doctor should state clearly that if the weight problem continues, you’ll suffer from severe well being dangers, leading to a shorter life span. The next are other matters that ought to be addressed in your request for preauthorization:
• The specific period of time you’ve gotten been in your doctor’s care expressly to manage your obesity.
• Details of your lively involvement in beneficial food plan or medication remedies. Embrace the amount of weight lost in following these recommendations and present that you’ve got suffered from continued weight acquire after attempting these programs.
• The current record of medical conditions instantly resulting from weight issues, and assurance that these points would enhance drastically upon shedding the surplus weight following gastric bypass surgery.
• The process anticipated to take place, the surgeon anticipate to carry out the process, the address and phone variety of the surgeon or bariatric treatment heart, and the anticipated length of hospital stay.
• An outline of the surgery, together with particulars of the benefits you search to achieve from gastric bypass surgery.
Before sending the request, do not forget to make copies for yourself and your doctor or surgeon, and fix all the supporting documents. You might also wish to send a letter via registered or certified mail, so you can mark the date when your request has been filed and have proof that it was received.
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