The first step is to fill out our online pre-qualification form to determine if you are a candidate for weight loss surgery. The National Institute of Health has set forth guidelines to determine who is an appropriate candidate for weight loss surgery and your insurance company and our surgeons follow those guidelines. One of our staff members will assess your individual situation and if you appear to be a candidate and would like to proceed, we will mail you our brochure, our health history form and secure a seat for you at our next seminar.
Schedule a Seminar
Once we determine that you are a candidate, you will attend an extensive educational seminar facilitated by the bariatric surgeon and staff members from Bariatric Surgery Specialists. People who have had the surgery may also be available to answer your questions. The seminar will include an overview of the program from a member of the administrative team, a power point presentation by the surgeon which includes information on all treatments for morbid obesity as well as surgical options and the risks and benefits of each. A question and answer session with the surgeon will follow. You will then receive extensive information about the insurance approval process and have the opportunity to ask any other questions you may have. You will be asked for a copy of your insurance card and picture ID as well as the completed health history form. You will be weighed, measured (height) and have vital signs checked upon arrival. There is no charge for the seminar, however, if you want to proceed with finding out whether or not your insurance covers surgery, we must have this information. At this time, you will also be asked which procedure you want to have. In some cases, your insurance company may determine that for you and in some cases a particular health problem will be contra-indicated for a procedure. Approximately 99% of the time, you will make the decision yourself.
Confirm Medical Acceptance
Once you have attended the seminar, the surgeon will review your height and weight taken at the seminar to determine if you meet National Institute of Health criteria. To be considered a candidate for surgery, you must have a BMI of 40 or higher or a BMI of 35-39.9 with certain co-morbid conditions. Now the surgeon must determine if the benefits of surgery outweigh the risks and this is done by the surgeon reviewing your health history form. Once the surgeon determines that you are a candidate based on BMI and your health history, your case will be assigned to the insurance department. There are certain occasions when the surgeon will need more information, require medical records, order medical tests or require you to return to be physically examined before he is able to accept you as a patient.
Insurance Benefits Verification
Congratulations! You have made through the first step and have been accepted as a candidate to continue towards surgery. Now we must determine if your insurance will pay for surgery. Coverage for Bariatric surgery can be very complicated. We will contact the benefits department of your insurance company and ask several questions. If you called prior to attending the seminar, you probably talked to customer service and were automatically told all "medically necessary treatment" is covered. Unfortunately, some insurance companies and employers have decided to put "exclusions" in health insurance policies. So even if the surgeon deems it "medically necessary", you may not have coverage for this particular health problem and treatment and may have to consider privately paying or changing policies. We will determine if you have appropriate coverage for the "surgical treatment of morbid obesity and if so, what requirements your insurance company will have. Every insurance company has different rules and your specific policy may have different requirements. We will call you within 48 hours of attending the seminar and let you know the status of your case, i.e., if you are/are not accepted as a patient and if you do/do not have coverage. We will also let you know what financial obligations you can expect. *At this point, certain surgeons will require an individual office visit.
Congratulation again! You have been accepted as a patient and you have benefits to proceed with surgery. Now we must get you approved. Again, each insurance company has different requirements for approval and your individual policy may have additional requirements. We may need to obtain up to five years of medical records to document your history of morbid obesity, we may need to obtain all of your diet records and you may need to have several months of medically supervised diet in order to get approval. If this is required, it is the perfect opportunity to make changes to optimize your post-operative success. The good news is that we can help you get whatever it is that is required. If for any reason your particular policy has a requirement that is impossible to meet or if for some reason you receive a "denial" of approval, we have an expert "Appeals" coordinator who will work hard to overturn your case. Once we get everything together, we will submit the final medical file to your insurance company and follow up closely. Bariatric surgery is the only medically necessary treatment that requires written approval from your insurance company. Until we receive the written authorization, we cannot proceed with surgery. At this time, if you decide to change the procedure, we will usually have to start the approval process over with your insurance company.
You did it! You got approved and now you are moving towards a surgery date. The first thing we determine is when you want surgery. Once we have an idea of when you can have surgery based on your schedule and the surgeon's schedule, we need to get all of your pre-operative testing completed. Pre-operative testing requirements are individualized to your health history and current medical conditions and BMI. The procedure you are having will also determine what testing will be required. All of our bariatric surgeons carefully evaluate your individual risk factors and will order testing accordingly. If they order it, there is a sound medical reason and it will be required prior to surgery. If results come back abnormal, your surgeon may order additional tests. We will set up your testing and once we get all of the test results back, we can proceed with the next step…pre-operative education and your one to one appointment with the surgeon.
Pre-Op Education and Conformed Consent
Prior to your appointment with the surgeon, you will attend a pre-operative meeting facilitated by our dietitian. During this session, you will go through an extensive informed consent process and sign several documents. We strongly encourage you to bring a family member or friend. You will also receive extensive education about your procedure and the post-operative diet. You will be given everything in writing. You will have all the time you need to ask all of your questions about your post-operative diet and follow up care. You may also be required to attend a support group meeting prior to your surgery date. You may also be required to sign a bariatric commitment form, which indicates your commitment to following the surgeon's orders, recommendations and follow-up schedule.
History and Physical / Visit With Surgeon
One to two weeks prior to having surgery you will have an appointment with surgeon. Prior to this time, your surgeon has reviewed your health history form and all of your test results. During this visit, you your surgeon will conduct your history and physical (a review of your health history, current conditions, test results, medications you are taking and conduct a physical exam). Your surgeon will review the surgical procedure, discuss the risks of the surgery, review informed consent and answer any questions you may have. We also strongly encourage you to bring a family member or friend to this visit. If there were any abnormal test results or there is a problem with proceeding with surgery, your surgeon will discuss it with you at this time. Otherwise, the next step is surgery.