Getting Authorization - Overview

Ok, at this point you should have covered the things listed below:

• Researched candidate surgeons you feel comfortable with.
• Contacted your insurer with specific questions.
• Narrowed your surgeon selection based on network participation and surgery type covered.
• Set your expectations for approval/denial/possible cash-payment routes.

Explore the “plan of attack” section for more information.

Where to go from here?

The next step, assuming you are working with insurance, is to get that plan to cover your surgery. This requires letters from clinical specialists, along with a letter of medical necessity from your primary care physician. Note that bariatric centers generally have their own way of handling these things, and, if you have a good one, then you might have the option of sitting back and letting them handle everything with success. If, however, you want to take a more active role (and possibly speed things up considerably), these pages outline the steps required.

What we need to do now:

1. Schedule appointments with and get letters from:
   1. Dietician
   2. Psychologist (“Psych Eval”)
   3. Sleep center (optional — documentation for sleep apnea)
   4. Other specialists as available
   (Note: You migh tneed to work with your PCP first to do the above.)
2. Create a letter of medical necessity
3. Work with your PCP:
   1. Educate him about the benefits and risks.
   2. Get him to sign or even augment the letter of medical necessity.
   3. Have him officially refer you to your bariatric surgeon.
   4. Motivate and prepare him to go to bat for you with the health plan, if need be.