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This Web site contains a compilation of more than a thousand consumer finance  columns written by Tony Novak from the 1980s through 2006, updated and reformatted for maximum usefulness today.  New material was added after 2010.

Content is the opinion of the author and does not represent the position of any other person or entity. Information is from sources believed to be reliable but cannot be guaranteed.

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Gastric bypass surgery approval

originally posted: 11/22/2006  reposted: 2/18/2011 This post has not been recently reviewed or revised by the author and may be out of date. If you notice an error or are in doubt, please send a new question by email or ask for an update. Email asktony@tonynovak.com.

Q: I need to know the requirements for this surgery. Usually you need a letter of medical necessity from the primary physician, a letter from a psychologist, and a letter from a nutritionist

A: As far as we know, there is no generalized procedure for getting insurance pre-approval for gastric bypass surgery and so it is handled on a case-by-case basis. Some insurers are pretty liberal and others have taken an absolute stand that the procedure causes more medical problems than it creates. In any case, one thing is clear - you should let the professionals handle your pre-approval. This is not an area for do-it-yourselfers. The staff at doctors' offices and hospitals handle pre-approval procedures on a daily basis and so they are experts on it. Their financial survival depends on getting insurance approval for recommended procedures. In the event the procedure is not approved then your doctor may wish to discuss alternate treatment that is less invasive. As a more general comment, we notice a growing public perception that gastric bypass is an "ordinary and necessary medical treatment" and yet there does not seem to be the same perception among the medical community and, equally important, among health insurance companies.

Summary

More resources:

health care costs after gastric bypass surgery