What can I do before my appointment to speed up the process?

• Speak to your insurance company. Ask them to specify if bariatric surgery is a covered benefit in your policy. You will need to provide them the surgical code CPT-43644 for gastric bypassor CPT-43775 for sleeve gastrectomy and to receive this information. Not only insurance companies vary in their coverage of weight loss procedures, individual policies may also vary in their nature. Some policies may have “exclusion clauses” and may not cover bariatric surgery. It is very important that you ask your insurance company to be very specific about their company’s policy and your own policy as they pertain to bariatric surgery.
• Gather all of the information your insurance company may require. This may include diet records, medical records, medical tests going back at least 2-5 years depending on the insurance company. This reduces the chance of being turned down because you failed to provide necessary information. Letters from your personal physician and professionals supporting the medical necessity of treatment are particularly valuable. When several physicians report the same findings, it may confirm a medical necessity for surgery.
• Choose a primary care physician if you don’t have one already, and establish a relationship with him or her. Work with your physician to ensure that your routine health maintenance testing is current. Results of diagnostic and routine screening for co-morbid conditions such as type 2 diabetes and high cholesterol can be necessary for documentation of medical necessity.
• Make a list of all the diets you have tried (a diet history) and take it to your doctor.
• Bring any relevant medical data to your first office visit, including reports of special tests (echocardiogram, sleep study, etc.), or a hospital discharge summary if you have been in the hospital for weight-related health problems.
• Bring a list of your medications, including dosage and schedule.
• Quit smoking. Surgical patients who use tobacco products are at a greater surgical risk. Talk to a doctor for help with this.
• When you send your letter, call your insurance carrier regularly to ask about the status of your request. Your employer or human relations office also may be able to help you work through any issues. Be sure to write down dates and the names of people you speak with and keep notes about the conversations. When possible, get them to fax you copies of the policies they are quoting.
• Make sure your primary care physician is documenting your weight loss efforts and your weight in your medical records at every visit.

Good article......did just what it said. I got printout of what my insurance would require and used it as a checklist. I called the Dr. and got copies (they sent them on a CD)of my medical records. I work with a dietician...got her to fill out all of the paperwork that I had been on a supervised diet. I walked in on my first visit with a big folder of all my papers......the insurance clerk was lost for words....stated that she had never had a patient to walk in with all the paperwork.

I started the process in April of this year. Had to have 4 visits with my PCP and 1 with nutritionist. 3 wks for insurance to approve. Pre-op is tomorrow 10/3 and surgery is 10/9. I asked for a case manager with my insurance copy, she confirmed everything I needed and check on the approval status.

Make sure the nutritionist you see is at a Bariatric Surgery office or is VERY familiar with the insurance process, not some random nutritionist your GP recommends. Even if you don't go with that doctor for surgery, the nutritionist's visits are worth gold.

The paperwork will be submitted to insurance and the random nutritionist may not have the kind of notes from your visits that are acceptable for insurance companies. Apparently, it happens all the time. You'll have to have them redone at extra cost and months delay.

Perhaps I should have mentioned, most insurance companies require 3 or 6 months of nutrition counseling (NUT). Sometimes you may have to wait several weeks to see a Bariatric Doctor. I waited 8 weeks to see my first doctor and another 3 to see another whom I liked. Meanwhile doing the NUT consults will save wait time. But as I said above, select NUT carefully.

I requested copies of my medical records from my pulmonary dr (sleep apnea) and my rheumatologist. I want to be prepared like you when I visit the surgeon in a couple of weeks...so excited!

Ok thanks Beni. Maybe I will try to make an appt with the nut since I have to wait several weeks for my Bariatric dr.