Pre-operative
Educational Program
Our
educational program consists of several pre-surgery sessions
with our surgeon, as well as counseling with our psychologist,
and nutritionist. If
you wish to proceed with an evaluation for weight loss surgery
this process begins with an initial office consultation
with your surgeon. At that point you will undergo a medical
evaluation as well as being enrolled into the program for
preoperative education and medical preparation. This process
follows a predetermined pathway that includes:
• Education and counseling with the surgeon
• Psychologic evaluation
• Nutrition evaluation
• Specialty consults and tests when necessary (e.g.:
lung/heart tests, sleep study, etc)
• Preoperative support group attendance
For
complete details on the program process
Click
Here
Listed
below are several excellent videos that will help explain
the various surgical weight loss procedures:
Insurance
Information for
Weight Loss Surgery Patients
Deciding to have weight loss surgery
is a very big decision. The process generally begins by
checking with your insurance carrier about coverage of benefits.
If you contact Trinity Bariatrics, they will verify insurance
information for you. It is a requirement that we
check all benefits before scheduling your initial appointment.
Some insurance plans unfortunately do not have benefits
for weight loss surgery. We have found it helpful to call
the insurance company’s customer service number and
ask if gastric bypass (CPT: 43644) or adjustable gastric
banding (CPT: 43770) is a covered procedure for the diagnosis
of Morbid Obesity (Diagnosis Code: 278.01). Be sure
to ask your insurance carrier specifically if surgical treatment
for Morbid Obesity is an excluded benefit.
You will either be told that it is covered if “medically
necessary,” or that it is not a covered procedure.
If it is covered when “medically necessary”
we will assist you in obtaining prior authorization. If
it is not a covered procedure, then choices are often limited
except for a cash pay option (see below).
Obtaining
authorization from your insurance company for obesity
weight loss surgery can be a challenging and frustrating
process. We will assist you in this endeavor, but your cooperation
in providing the following documentation will improve your
chances of obtaining approval
1 . We need as much documentation as you can provide regarding
your attempts at dieting and, in particular. any medically
supervised diet plans. Writing your own letter of medical
necessity to your insurance company is also a good way
to reinforce the difficulties you may be experiencing
with your weight.
2 . Documentation of any associated medical problems such
as hypertension, diabetes, sleep apnea, or orthopedic
problems. Letters from specialists or personal physicians
in support of the surgery are particularly beneficial.
Obtaining approval can take up to 4 weeks to complete. Many
companies deny an initial request for no apparent reason,
despite our policy of utilizing NIH national criteria in
patient selection. In the event you receive a denial, you
need to go through the proper channels and appeal. We will
assist in this matter, but the appeal must come from the
policyholder. Our experience shows that many companies will
back down and approve coverage when faced with a determined
patient. If all else fails, and you feel that you have a
good case for medical necessity, legal assistance is available
to handle an appeal at a reasonable fee.
If
you have Aetna, Cigna and some United HealthCare
and BCBS AL, BCBS IL, BCBS NJ, and HighMark BCBS as your
insurance provider, it is a requirement that you must have
undergone a medically supervised diet for a 6 month period
within the last 24 months before any documents will be considered
for approval. You can contact our office for the information
to provide your primary care doctor to start this process.
The
documentation must include:
1. Vital Signs, including weight
2. Current dietary program
3. Physical activity (i.e.: exercise program)
4. Behavioral interventions to reinforce healthy eating
& exercise habits
5. Consideration of pharmacotherapy with U.S. Food &
Drug Administration (FDA)
approved weight-loss drugs, if appropriate
