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It’s important that you grasp what “is” and “is not” included in your insurance provider. Do not attempt to get authorization for surgery yourself or ask you Primary Care Physician to do that. This must be done by our office staff in order to meet all coverage requirements. Get yourself a recommendation and copy of medical information from most of your care physician. Keep accurate, detailed records of visits to healthcare providers.

Also, save receipts for just about any exercise equipment, fitness programs, diet centers, weight loss drugs and anything else that can assist in the authorization process. Current weight, height and BMI. Surgery recommended along with any post-operative follow-up care, including nutritional and psychological support. Three to Six (3-6) weeks of a documented exercise and dieting program (must include schedules and results).

If we have posted an authorization for surgery demands and it was rejected, we have the to appeal the decision in your stead. Being refused coverage for surgery happens to some patients and this initial problem does not mean that you’ve reached the end of the road. Some insurance providers may at first deny bariatric surgery claims automatically the first time they’re submitted, and can become more receptive to follow-up charm words and peer-to-peer reviews with medical directors.

  1. I cannot see any option to monitor my diet habit
  2. Diastasis recti causes pain
  3. Hives and rashes
  4. Carl, FL (testimony from company website)
  5. Do as much bodyweight squats as you can certainly do in 5 minutes

If you have questions about the insurance process, please don’t be reluctant to get hold of our office. Let our experienced bariatric team help you with the authorization process. AETNA: Standard NIH weight requirements, 5 years recorded by a health care provider history of obesity, supervised 6-month (or two 3-month periods) diet within 2 past years, evaluation by dietitian & psychologist.

Blue Cross/Blue Shield: Standard NIH weight criteria, supervised 6-month (or two 3-month intervals) diet within 2 previous years, evaluation by dietitian & psychologist. Blue Cross Federal: Standard NIH weight requirements, 3-6 months supervised diet, evaluation by dietitian & psychologist. CIGNA: Standard NIH weight criteria, supervised 6-month diet within 2 past years, evaluation by dietitian & psychologist. United/MAMSI/MDIPA/Optimum Choice: Standard NIH weight requirements, 5-year weight history, evaluation by dietitian & psychologist.

Some plans may necessitate six months supervised diet. United/MAMSI/MDIPA/Optimum Choice Federal: Standard NIH weight criteria, supervised 6-month (or two 3-month intervals) diet within former 2 years, evaluation by dietitian and psychologist. Medicare/Medicaid: Standard NIH weight criteria, supervised 6-month diet, evaluation by psychologist and dietitian, participation in preparation/conditioning program with surgeon for 3 months.

Eligible co-morbidities include hypertension untreatable with 2 or even more medications, type II diabetes, obstructive rest apnea, severe joint disease requiring joint substitution, or fatty liver organ. Weight loss of 10 percent or even more before surgery makes patient ineligible for surgery, and revision methods are not protected unless there is a complication of preliminary surgery.