This is the most time consuming and rate limiting step in Bariatric Surgery.
Pre-determination is a lengthy process and ONLY YOU can facilitate the process.

Process:

First step is to check for benefits and insurance requirements for approval. Our office will call your insurance company upon your instruction to verify benefits, approval requirements and pre-determination process.

Once availability of benefits is confirmed surgical consultation is scheduled.

In about 7-10 days after surgical consultation the letter of medical necessity is prepared ready to be sent to your insurance company

At this point we will be waiting for you to obtain and forward to us

• Copies of previous weight loss attempt receipts
• Past 5 year medical records from your physician
• Documentation of medically supervised weight loss
• Any other evaluations as needed by your insurance
• Any supporting letters from other physicians

Once we obtain all documents and complete the package we will send all the information to your insurance company.

It typically takes about 4-6 weeks for your insurance company to respond back and sometimes longer.

As soon as we hear from the insurance we will contact you.

Once an approval comes through we will move forward with the preoperative process and can schedule the surgery in 2-3 weeks from the approval date.

If insurance needs additional documentation we will notify you and you then need to obtain the additional documentation necessary. We will help you with that process.

If insurance denied the application then you may appeal. However most appeals are denied unless you fulfill all the requirements by the insurance company and were able to provide documentation.

If insurance coverage is denied or not an option then you may forward as self pay. We can schedule your surgery date within 2-3 weeks from your decision to move forward.

We will work with your primary care to get some of the pre-testing done in order to minimize your costs.

You may call our office or your insurance company at anytime in order to check the status of your application.

Our office will keep up with the insurance company in order to get expedited approval process.