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Gastric Bypass and Your Insurance, page 10
A 12-page report about gastric bypass and your health insurance
©2005 Jonni Good
“Pre-authorization” – What it Means
If gastric bypass surgery is covered under your policy, it is very likely that you will need to have the procedure pre-authorized. This means that your insurance company will need medical records, a treatment plan, and perhaps a letter from your primary doctor and surgeon to show that you meet their criteria for benefits.
If you have not already read your insurance company’s medical policy on gastric bypass surgery, you should do so before you ask your doctor to request pre-authorization. Your doctor’s staff may already have a copy of the medical policy, but if they don’t, it is always helpful if you provide this to them. If it isn’t available on your insurance company’s website, they should be mail you a copy if you ask for it.
Your doctor and surgeon may have a financial stake in helping you get insurance benefits, but the responsibility for finding the funds for your surgery is primarily on your shoulders. You should do everything you can to make the process easier for your doctor’s staff.
When they receive the pre-authorization request, your insurance company’s medical staff will go over the material provided by your doctor and decide if the criteria listed in the medical policy have been met. If your doctor believes that the procedure is necessary, even though some of the requirements have not been met, his or her opinion will need to be backed up by real facts and chart notes. A letter from your doctor that basically states “because I said so” is not going to impress your insurance company.
If you do not meet the insurance company’s criteria for benefits, and your doctor cannot document why you need the procedure anyway, you may want to carefully reconsider your decision to have the surgery. The surgery is not without risks, and should not be undertaken without very strong facts showing that it’s needed. If it is needed, your doctor should be able to say why in a way that is acceptable to other medically-trained professionals
The pre-authorization process should only take a few weeks, if the insurance company receives all the documentation that they ask for, but this may vary, depending on how your insurance company handles these requests. If your request is turned down even though you believe that your policy covers bariatric surgery, that you qualify under the medical policy’s guidelines, and that your doctor has provided all the documentation that was requested, you may need to appeal the decision.
Next Page of Gastic Bypass and Your Insurance Report
New research shows that low-calorie diets can cause food obsessions and binge eating. They can even make sugar addiction worse. No wonder most people end up fatter than they started when they try to lose weight with a low-calorie diet.
The answer? The New Craving Control Diet.
Lose 3 to 5 pounds a week without surgery, starvation diets or dangerous appetite suppressant pills. Enjoy the satisfying, delicious diet that controls your appetite naturally, reduces food cravings, and helps burn fat faster.
Finally - Fitness Without Pain:
Have
you ever purchased exercise videos you couldn't use because the exercises
were too strenuous or caused you too much pain? If so, I found the perfect
fitness program for you.
It's called the "Runner's Yoga" program, but it's definitely not just for runners.
These specially-selected yoga exercises are easy to learn, and take only 30 minutes for a full workout. They firm up your muscles, give you greater flexibility, and help calm the mind so you can concentrate better during the day.
And all without any pain at all. In fact, it can even help reduce pain if you now suffer from injured knees or joints.
To learn more about this new fitness yoga program, click here.
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