Gastric bypass surgery approval
originally posted: 11/22/2006 reposted: 2/18/2011 This post has not been recently reviewed or revised by the author and may be out of date. If you notice an error or are in doubt, please send a new question by email or ask for an update. Email asktony@tonynovak.com.
Q: I need to know the requirements for this surgery. Usually you need a letter of medical necessity from the primary physician, a letter from a psychologist, and a letter from a nutritionist
A: As far as we know, there is no generalized procedure for getting insurance pre-approval for gastric bypass surgery and so it is handled on a case-by-case basis. Some insurers are pretty liberal and others have taken an absolute stand that the procedure causes more medical problems than it creates. In any case, one thing is clear - you should let the professionals handle your pre-approval. This is not an area for do-it-yourselfers. The staff at doctors' offices and hospitals handle pre-approval procedures on a daily basis and so they are experts on it. Their financial survival depends on getting insurance approval for recommended procedures. In the event the procedure is not approved then your doctor may wish to discuss alternate treatment that is less invasive. As a more general comment, we notice a growing public perception that gastric bypass is an "ordinary and necessary medical treatment" and yet there does not seem to be the same perception among the medical community and, equally important, among health insurance companies.
Summary
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health care costs after gastric bypass surgery