Question:
Information the surgeon needs

I am calling the surgeon today to make the appointment for evaluation. What information should I gather to take with me, looking toward fighting for insurance approval?    — Danny K. (posted on July 10, 2000)

July 10, 2000
If your surgeon is on the ball and has dealt successfully with your insurance carrier in the past, his staff should be able to put together a request for authorization that will get the approval with the least hassle in the shortest time. My surgeon had me fill out a questionnaire (write my life story) detailing health problems, family health history (extensive, so ask your family for details, especially parents, aunts, uncles and siblings - what problems they've had, their own weight, what deceased relatives died from, etc...), my previous weight loss attempts and the results (how much did I lose, how much did I regain). He also included questions about mobility, struggles with daily tasks, all of the things that our weight can make more difficult. On top of this, he had me write in my own words how my weight has affected me socially, in the workplace, physically and emotionally. Armed with all this information, he ordered the pre-op tests that my insurance carrier required (among them psych and nutrtional evaluations) and submitted a five-page request for authorization, pointing out all the reasons it was medically and financially wise to approve the surgery. He does this for every patient, and most gain approval on the first submission. From what I've observed, the trick to an easy approval is making sure that the request for authorization submitted by your surgeon goes into some detail as to the medical necessity for WLS. The request certainly doesn't need to be five pages, but a simple paragraph requesting approval will most likely result in a denial, necessitating a fight that might have been avoided with a properly worded initial request. So go to see your surgeon armed with your health records (no telling what your doctor may have noted that will help your cause), your own list of physical, social and emotional problems caused of exacerbated by your weight, your diet history (do the best you can) and anything else you think will help. Most people I know haven't found it necessary to deal directly with their insurance carrier or even submit an appeal. If you know medical necessity is a criteria for approval, get your ducks in a row and prove it the first time and you may have a much easier time getting approval. Good luck to you!
   — Duffy H.