Washington, D.C. Weight Loss Forum

by Tracy Burch

When choosing a Realize Band surgeon, experience is a must. However, one thing most patients overlook is investigating the experience of the insurance team. The bariatric surgeon isn?t going to do much good if you can?t get insurance approval! As you begin your journey in finding a bariatric surgeon, make sure you do your homework on the entire team as well.

I find it very interesting that I am always asked the same handful of questions at each initial visit. The number one question I am asked is, "When can I have surgery?"  My response is always the same, "It?s up to you."  The truth of the matter is, this entire process is up to you. Sure, the insurance team will offer their experience as a guide. In the best of cases, their advice is correct. In some cases, it isn?t. What then? For starters you get denied. I won?t even begin to embark on what the appeals process is like, because my goal here is to provide you with the knowledge to prevent a denial and ensure a speedy approval.

Perhaps the better question from above would have been: What can I do to get approved?

The best thing you can do for yourself is to become your own best advocate from day one. The more you know about your specific insurance plan, the more likely you are to get approved. I consider myself very experienced, but insurance plans change all the time. By educating yourself on your insurance plan, you can help eliminate the possibility of missing new or changed criteria.

These days, a lot of insurance plans are requiring physician supervised diets. Most patients that come into our office have been considering weight loss surgery for 6 months or more. Sadly, they don?t act on their thoughts and they do nothing more than internet research and possibly visit with their family physician for a referral. While I do think both are a great place to start, I would highly recommend the moment you start researching weight loss surgery, also start a supervised diet with your family doctor. These visits should be at least one time a month and it is crucial that you meet with the physician at each visit. The entire visit must be documented in your chart and a weigh in alone will not suffice. It is unfortunate that patients make the major decision to have weight loss surgery, only to find out a supervised diet is required and then just give up on their weight loss surgery dreams.

Another common mistake that can be easily avoided is failure to provide documentation supporting your co-morbidities. Please remember, we must provide evidence to your insurance company on why they should pay for an elective procedure. If you walk into your weight loss surgeon?s office empty handed and say that you don?t see a doctor on a regular basis, odds are we can?t help you. It is important to see a physician on a regular basis, so we can be given the proper documentation to help you get approved.

I realize the entire insurance process is very overwhelming. However, knowledge is power and when all is said and done, only YOU have the power to change your own life.

Good Luck to all!

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This information has been provided by Dr. Trace Curry and his team at the Center for Metabolic and Bariatric Surgery. To learn more about the Center for Metabolic and Bariatric Surgery, please visit http://www.thebanddoctor.com/.