While many major companies and health insurance carriers recognize the long-term benefits of surgery for morbid obesity and approve the procedure, there are no universal or standard criteria for weight surgery within the insurance industry. For this reason, it is our policy to request written prior approval for surgery from the health insurance carrier in every case. Pre-approval with insurance can be a long difficult process and persistence with patience is a must.
Please be aware of the following during the prior authorization period for surgery:
- our insurance company may require additional medical records and/or tests from other physicians.
- The letter for pre-approval may only be sent after all requested information has been received in our office.
- We will inform you if the insurance requests additional information and/or approves/denies the request for authorization.
The majority of insurance companies that cover the procedure require a patient to have the following criteria (Call your insurance company to check on coverage and criteria for complete information):
- Body Mass Index of at least 40 or Greater.
- Body Mass Index of 35 with co-morbidities known to be improved by weight loss i.e. type II diabetes, high blood pressure, sleep apnea etc.
- Psychological Evaluation.
- Nutrition Consultation.
- History and Physical from your Primary Care Physician recommending weight loss surgery.
- Complete Diet History.
- 3 to 6 months of a Medically Supervised Weight Loss Program Prior to Surgery.
