Moving Forward:

Our seminars are designed to be a stepping stone towards eventual insurance approval, surgical consultation, and the ultimate goal of surgery. All persons who attend one of the informational seminars will receive a blue folder filled with written materials including the paperwork needed to begin the insurance approval process with our program. We include specific instructions on how to fill out the paperwork as well as information about gathering of medical records that your insurance company will require for prior authorization. See Insurance and Financing for more on checking your benefits and plan exclusions.

The Insurance Approval Process

Most insurance companies that provide weight loss surgery benefits to their subscribers require that the surgery go through a “predetermination” process. This means that the insurance company has created a set of criteria that the patient desiring surgery must meet before they will offer “prior approval.” Prior approval, per insurance policy, is not a guarantee of benefits. Please refer to your plan document for details. The predetermination process usually requires that the patient meet some physical standards, and some patients are required to undergo psychological and physical testing.

A “typical” set of criteria would include:

A BMI > 40, or 35 to 39 with serious co-morbidities,
12-24 month diet history,
Documentation of health history and co-morbidities,
A psychological evaluation
A nutritional consultation
3 months of medically supervised dieting in the past 6 months, and
Labwork to rule out thyroid dysfunction or metabolic imbalance.

Please remember, this is only an example.

Each insurance company has different criteria that a patient must meet in order to be authorized for surgery, and even different plans within a company can vary in their requirements. At the Bariatric of Kansas City, we work closely with you to gather your records and arrange the testing and consultations needed to fulfill these requirements as quickly as possible. Once all of the information is gathered, we’ll write your letter of medical necessity and submit it along with your other documentation for predetermination.

Frequently Asked Questions:

Should my primary doctor write my letter of medical necessity?
No, as your surgeon, that is our role. Even though your primary doctor is trying to be helpful, the insurance company expects your surgeon to send in all your information. However, if your primary or specialist physicians wants to write a letter of support that can be very helpful. Mostly what we need from your primary doctor is medical documentation of your health status that past couple of years, and what efforts you have made to lose weight under his/her guidance.
How long does insurance approval take?
Once your letter of medical necessity is submitted, it can take as little as 48 hours to as long as 6 weeks, or even longer, depending on the insurance company. That’s why it’s important that we send all the information in correctly the first time so delays are avoided.
How can I help with the insurance approval process?
Please make sure that your doctor(s) forward your medical records to our office as soon as possible. Instructions for having records sent to our office are included in the blue folders distributed at the informational seminars. Once you know your predetermination request has been submitted, contact your insurance company weekly to check on its status. Make sure your insurance company actually received the request and remind them that you’re anxious to be approved.

**For Self Pay Patients: If you’re interested in moving forward with surgery after attendance at the Informational Seminar, the process varies a bit for you. Please review your seminar information carefully for specifics.

Consultation with Your Surgeon

Once a patient has been pre-approved through his insurance, or has made self-pay financing arrangements, you are ready to start some of your consultations and testing, and consult with your surgeon as well. We will assist you with the arrangements of your preoperative consultations and your first appointment in our office. Please be prepared by this time to choose your surgeon, and if you are still unsure of which procedure you desire, please discuss this with our staff before your consultation.

Note: Insurance approval or an initial consultation with the surgeon does not guarantee that a patient is a candidate for our weight loss surgery program. Candidacy is being evaluated throughout the entire preoperative phase by all disciplines involved in your care. The bariatric program and our surgeons reserve the right to dismiss a patient from the program without cause at any time.

Over the past years we have developed the following general sequence for our weight loss surgery patients:

Patient attends informational seminar
Paperwork is completed by patient and submitted to our office along with medical records as required for insurance predetermination
If patient’s insurance company requires specific criteria be met, our office will contact the patient and arrange consultations, testing, or discuss other details.
Once the patient meets the insurance criteria, our office submits letter of medical necessity to insurance company along with other required information.*
Patient receives either prior-authorization for surgery* or is notified of denial
If approved, patient makes office consultation appointment with surgeon and begins pre-surgical consultations and testing
At office consultation with your surgeon, your surgeon will review your records, answer your questions and consider you for candidacy for the program. A surgery date will be arranged if your surgeon feels it is appropriate.
Lap Band patients are only seen once in our office before surgery; Gastric Bypass patients are seen twice.
Special note to self-pay patients: payment is not required by our office or by the health care facilities until immediately before the date of surgery.

*Does not pertain to self-pay patients

Meeting With Your Surgeon

At your first surgical consultation, you will be meeting with your surgeon to discuss in more detail the procedure you have chosen and how it will affect you and your lifestyle. Your specific health issues will be reviewed, and the risks and benefits of the surgery will be addressed as well. You will have the opportunity to ask many questions, and you will be given educational information, and in most cases, a surgical date will be chosen. You will have the opportunity to meet the office staff as well. We encourage you to bring family members or support persons with you to this initial consultation. You will eventually be asked to sign a consent indicating that you understand the nature of the surgery itself, along with the risks and benefits.

Patients undergoing the Laparoscopic Roux-en-Y gastric bypass will be required to attend a second office consultation with their surgeon approximately one week before their surgery, for final review of all lab testing and consultation reports. At that second consultation you’ll be taking a simple pre-operative test which helps us rate your level of comprehension regarding the nature of the surgery and your readiness for the procedure itself.

Multidisciplinary Consultations

Our program’s philosophy is based on caring for the whole patient, physically and mentally, to enhance their ability to succeed with the weight loss surgery that they have chosen. That is why we do everything we can to make sure that each patient is prepared as fully as possible for their upcoming surgery. This involves sending our patients to outside consultations with experts in the fields of cardiology, pulmonology, and clinical psychology, as well as referring them to nutritional experts, exercise therapists, and an experienced bariatric hospital coordinator. We all work closely with the patients’ own primary care physicians or internists, as well as their endocrinologists and orthopedists, to help ensure that they are medically stable and good candidates for surgery.