We realize that most people are depending on insurance to cover the majority of the cost of gastric bypass. To expedite this, we will write a letter to your insurance company requesting a pre-authorization (or pre-determination of benefits) for this surgery. This is done to ensure that authorization is given to us in writing prior to scheduling your surgery date, which protects you from non-coverage later. A copy of the pre-authorization letter is sent along with you claim form after surgery to prove that this procedure was deemed medically necessary and that it is a covered benefit in your policy.
This process can take a while to complete, as it takes approximately three to six weeks to receive a response back form the insurance company after the letter is submitted (in some cases even longer). However, many insurance companies will request additional information in the form of past medical records (sometimes as far back as five to ten years), and in some cases a psychiatric evaluation is required before the insurance company will issue an authorization. Pleas be patient, as we will endeavor to do whatever we can to obtain authorization for your surgery.
Unfortunately, in a lot of instances, gastric bypass is listed as a policy exclusion. This means that that particular insurance policies will not provide coverage for this surgery, even if they deem it to be medically necessary.
If the insurance carrier denies the surgery because it to be ”not medically necessary,” we can possibly appeal that decision and provide additional information or documentation of your weight history and medical problems to get them to reverse their decision. We will assist you in any way possible to achieve this.
You can call your insurance carrier to get a fax number for the pre-authorization (or pre-determination) department, and we will be glad to fax your information instead of sending it by mail, as it has been our experience that this speeds up the process somewhat.
PLEASE NOTE: We are considered to be out of network for most insurance companies. If we are not a preferred provider for your insurance company’s network, you will be asked to pre-pay the portion of your bill that insurance will not pay. The amount required before surgery varies, as some insurance companies will pay 80-90% to an out of network provider, while others may reduce your benefits to as low as 60-70%.
If you have any questions concerning obtaining insurance approval for gastric bypass, please feel free to call us at the office.