STEP (1)
Pre-Qualification
Form
The first step is
to fill out our
online
pre-qualification form
to determine if you are
a candidate for weight
loss surgery. The
National Institute of
Health has set forth
guidelines to determine
who is an appropriate
candidate for weight
loss surgery and
your insurance
company and our
surgeons follow those
guidelines. One
of our staff members
will assess your
individual situation
and if you appear to be
a candidate and would
like to proceed, we
will mail you our
brochure, our health
history form and secure
a seat for you at our
next seminar.
STEP (2)
Schedule a Seminar
Once we determine
that you are a
candidate, you will
attend an extensive
educational seminar
facilitated by the
bariatric surgeon
and staff members from
Bariatric Surgery
Specialists. People who
have had the surgery
may also be available
to answer your
questions. The seminar
will include an
overview of the program
from a member of the
administrative team, a
power point
presentation by the
surgeon which includes
information on all
treatments for morbid
obesity as well as
surgical options and
the risks and benefits
of each. A
question and answer
session with the
surgeon will follow.
You will then receive
extensive information
about the insurance
approval process and
have the opportunity to
ask any other questions
you may have. You
will be asked for a
copy of your insurance
card and picture ID as
well as the completed
health history form.
You will be weighed,
measured (height) and
have vital signs
checked upon arrival.
There is no charge for
the seminar, however,
if you want to proceed
with finding out
whether or not your
insurance covers
surgery, we must have
this information.
At this time, you will
also be asked which
procedure you want
to have. In some
cases, your insurance
company may determine
that for you and in
some cases a particular
health problem will be
contra-indicated for a
procedure.
Approximately 99% of
the time, you will make
the decision yourself.
STEP (3)
Confirm Medical
Acceptance
Once you have attended
the seminar, the
surgeon will review
your height and weight
taken at the seminar to
determine if you meet
National Institute of
Health criteria. To be
considered a candidate
for surgery, you must
have a
BMI of 40 or
higher or a BMI of
35-39.9 with certain
co-morbid conditions.
Now the surgeon must
determine if the
benefits of surgery
outweigh the
risks and
this is done by the
surgeon reviewing your
health history form.
Once the surgeon
determines that you are
a candidate based on
BMI and your health
history, your case will
be assigned to the
insurance department.
There are certain
occasions when the
surgeon will need more
information, require
medical records, order
medical tests or
require you to return
to be physically
examined before he is
able to accept you as a
patient.
STEP (4)
Insurance Benefits
Verification
Congratulations! You
have made through the
first step and have
been accepted as a
candidate
to continue towards
surgery. Now we
must determine if your
insurance will pay for
surgery. Coverage
for Bariatric surgery
can be very complicated.
We will contact the
benefits department of
your insurance company
and ask several
questions. If you
called prior to
attending the seminar,
you probably talked to
customer service and
were automatically told
all “medically
necessary treatment” is
covered. Unfortunately,
some insurance
companies and employers
have decided to put
“exclusions” in health
insurance policies.
So even if the surgeon
deems it “medically
necessary”, you may not
have coverage for this
particular health
problem and treatment
and may have to
consider
privately
paying or changing
policies. We will
determine if you have
appropriate coverage
for the “surgical
treatment of morbid
obesity and if so, what
requirements your
insurance company will
have. Every insurance
company has different
rules and your specific
policy may have
different
requirements. We will
call you within 48
hours of attending the
seminar and let you
know the status of your
case, i.e., if you
are/are not accepted as
a patient and if you
do/do not have
coverage. We will
also let you know what
financial obligations
you can expect. *At
this point, certain
surgeons will require
an individual office
visit.
STEP (5)
Insurance Processing
Congratulation again!
You have been accepted
as a patient and you
have benefits to
proceed with surgery.
Now we must get you
approved. Again, each
insurance company has
different requirements
for approval and your
individual policy may
have additional
requirements. We may
need to obtain up to
five years of medical
records to document
your history of
morbid
obesity, we may need to
obtain all of your diet
records and you may
need to have several
months of medically
supervised diet in
order to get approval.
If this is required, it
is the perfect
opportunity to make
changes to optimize
your post-operative
success. The good news
is that we can help you
get whatever it is that
is required. If for any
reason your particular
policy has a
requirement that is
impossible to meet or
if for some reason you
receive a “denial” of
approval, we have an
expert “Appeals”
coordinator who will
work hard to overturn
your case. Once we get
everything together, we
will submit the final
medical file to your
insurance company and
follow up closely.
Bariatric surgery is
the only medically
necessary treatment
that requires written
approval from your
insurance company.
Until we receive the
written authorization,
we cannot proceed with
surgery. At this time,
if you decide to change
the procedure, we will
usually have to start
the approval process
over with your
insurance company.
STEP (6)
Pre-Op Testing
You did it!
You got approved and
now you are moving
towards a surgery date.
The first thing we
determine is when you
want surgery.
Once we have an idea of
when you can have
surgery based on your
schedule and the
surgeon’s schedule, we
need to get all of your
pre-operative testing
completed.
Pre-operative testing
requirements are
individualized to your
health history and
current medical
conditions and BMI.
The procedure you are
having will also
determine what testing
will be required.
All of our
bariatric surgeons
carefully evaluate your
individual risk factors
and will order testing
accordingly. If
they order it, there is
a sound medical reason
and it will be required
prior to surgery.
If results come back
abnormal, your surgeon
may order additional
tests. We will set up
your testing and once
we get all of the test
results back, we can
proceed with the next
step…pre-operative
education and your one
to one appointment with
the surgeon.
STEP (7)
Pre-Op Education and
Conformed Consent
Prior to your
appointment with the
surgeon, you will
attend a pre-operative
meeting facilitated by
our dietitian. During
this session, you will
go through an extensive
informed consent
process and sign
several documents. We
strongly encourage you
to bring a family
member or friend. You
will also receive
extensive education
about your procedure
and the post-operative
diet. You will be
given everything in
writing. You will have
all the time you need
to ask all of your
questions about your
post-operative diet and
follow up care.
You may also be
required to attend a
support group meeting
prior to your surgery
date. You
may also be
required to sign a bariatric
commitment form,
which indicates your
commitment to following
the surgeon’s orders,
recommendations and
follow-up schedule.
STEP (8)
History and Physical
/ Visit With Surgeon
One to two weeks prior
to having surgery you
will have an
appointment with
surgeon. Prior to
this time, your surgeon
has reviewed your
health history form and
all of your test
results. During
this visit, you your
surgeon will conduct
your history and
physical (a review of
your health history,
current conditions,
test results,
medications you are
taking and conduct a
physical exam).
Your surgeon will
review the
surgical procedure,
discuss the risks of
the surgery, review
informed consent and
answer any questions
you may have. We
also strongly encourage
you to bring a family
member or friend to
this visit. If
there were any abnormal
test results or there
is a problem with
proceeding with
surgery, your surgeon
will discuss it with
you at this time.
Otherwise, the next
step is surgery.
STEP (9)
Hospital Admission
STEP (10)
Follow-Up Care
