Checklist for Insurance Approval
Benefits: Call the customer service number at your insurance company, and ask for the benefits department. Ask if you have benefits for bariatric surgery. This information can also be found written in your policy on the exclusions page. You may be asked for CPT Codes, which are:
- Lap Banding 43770
- Sleeve Gastrectomy 43633
- Gastric Bypass 43644
Surgical Clearance: This exam is used to determine that a patient does not have any underlying medical conditions that would prohibit them from having surgery. A letter/copy of the exam notes needs to be sent to our office after each exam is complete.
Pre-operative Lab Work: Each patient will be asked to have labwork completed, with a copy of your results sent to our office upon completion.
Diet Records: You will be asked to provide documentation of all recent medically supervised weight loss attempts. Most insurance companies require proof that you have tried physician-supervised weight loss attempts. We will review your insurance company requirements with you at you initial consultation visit.
Medical Records: Any visits to a doctor, surgeries, lab results, diagnostic procedures and ER visits should be included. Request records pertaining to your weight and any conditions worsened by your weight, such as hypertension, diabetes, degenerative joint disease, etc. We need records dating back five years, unless insurance indicates a need for more.
Psychological Evaluation: The importance of obtaining a thorough psychological assessment cannot be overstated. A detailed clinical interview and objectively scored psychological tests should be part of a comprehensive psychological evaluation. Many insurance companies require an evaluation for benefits and our surgeons require an evaluation for all patients.