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Blue cross weight loss benefit form maryland verification#

AETNA: Standard NIH weight criteria, 5 years documented by a doctor history of obesity, supervised 6-month (or two 3-month periods) diet within 2 past years, evaluation by dietitian & psychologist.Most frequently encountered requirements by insurance company: If you have questions about the insurance process, please don’t hesitate to contact our office. Some insurance providers may initially deny bariatric surgery claims automatically the first time they are submitted, and can be more receptive to follow-up appeal letters and peer-to-peer reviews with medical directors. Being denied coverage for surgery happens to some patients and this initial set back does not mean that you’ve reached the end of the road. If we have submitted an authorization for surgery requests and it was denied, we have the right to appeal the decision on your behalf. Evaluation by surgical bariatric dietician.A psychological/psychiatric evaluation.Three (3) to six (6) months of a documented dieting and exercise routine (must include dates and results).Medical records including your evaluation, treatments performed to date, and specific types of lab work done.A detailed medical history including co-morbidities (i.e., the presence of one or more diseases in addition to obesity).Surgery recommended along with any post-operative follow-up care, including nutritional and psychological support.

Blue cross weight loss benefit form maryland verification#

Verification from a physician that you are 100 pounds or more over your ideal body weight.

The insurance company will typically ask for the following information and documentation (Please be prepared to assist us with providing these upon request):

Keep accurate, detailed records of visits to health care providers for non-surgical weight loss programs when required by your plan.

Get a referral and copy of medical records from your primary care physician if required.

Read and understand your insurance provider’s policy of coverage.

Here are some helpful hints to assist with the authorization process:

This must be done by our office staff in order to meet all coverage criteria. It’s important that you fully understand what “is” and “is not” covered by your insurance provider, however, do not attempt to get authorization for surgery yourself or ask you Primary Care Physician to do so. Insurance companies are frequently changing their coverage criteria and have multiple medical plans, so please call you insurer’s member services number and confirm current requirements and eligibility for bariatric surgery coverage relevant to your case. Bariatric surgery in Maryland is often covered by insurance provided you meet certain eligibility criteria.