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Patient Education
Authorization Process

How Do I Obtain Pre Authorization

In most states, legislation requires insurance companies to provide benefits for weight loss surgery when patients meet the National Institutes of Health criteria. Though insurance coverage is widespread, you should prepare for a lengthy approval process. (It can take anywhere from one (1) to six (6) weeks*.).

Below are steps to increase your chances of being approved for Bariatric Surgery:

  • Read and understand your insurance company's Certificate of Coverage. You can get this directly from your employer's benefits administrator of your insurance company.
  • Get a referral from your primary care physician if necessary. Even if you don't need one, you must have your doctor's support.
  • Keep accurate, detailed records and save all receipts.
  • Document every visit to healthcare professionals for obesity-related issues, including weight loss programs, diet centers and fitness clubs.
  • Complete Behavioral/Nutrition evaluations as quickly as possible. Remember, the sooner you get us the information we need, the sooner we can get you authorized.

Getting Started

  • Call your insurance company and ask if there are any exclusions against weight loss or obesity surgery.
  • Remember to get the first name and last initial of the person you speak with every time you call your insurance company.
  • If you have an insurance provider that we do not participate with, please be sure to find out if you have any out-of-network benefits, and what they are.
  • Ask if your coverage has any pre-existing clauses that may affect you having bariatric surgery.

Authorization Process

  • Send a letter to your primary care physician asking him/her to write a letter to establish the medical necessity of your weight loss surgery by proving:
  • You are morbidly obese and have a BMI of 40 or higher.
  • You have been obese for the past five years or longer.
  • You have attempted, under your physician?s care, other methods of weight loss for at least two (2) years. These may include: Behavior Modification; Optifast; Medifast; Drug Therapy; Overeaters Anonymous, or diet centers.
  • You have, or may have, co-morbidities such as: Hypertension; Diabetes; Sleep Apnea; degenerative Arthritis; or Heart Disease, which merit consideration of medical necessity for surgery.
  • If your BMI is between 35 and 39, it is important that your doctor documents any and all of your co-morbidities in the letter of medical necessity.

Finally, if you have any questions regarding your insurance, feel free to contact our Insurance Department. But please be patient, as we are working extremely hard to make sure that everyone's surgery gets approved!