Using the active participant approach, the obese person considering gastric bypass surgery or other form of weight loss surgery should have at least some idea of what will be involved to obtain insurance authorization. In the passive approach, the obese person may still be in the dark. Either way, the bariatric surgeon's office will not perform the gastric bypass operation or other form of weight loss surgery unless they have written insurance authorization to proceed with the weight loss surgery. In the simplest form, if the bariatric surgeon operates without authorization, they will not get paid. The redeeming quality of this concept is that once the person has been determined to be a candidate for the gastric bypass surgery or other form of weight loss surgery during the office visit, the surgeon's office staff will become part of the team seeking to get the insurance authorization.
The surgeon's office will provide the correct diagnosis codes (ICD-9) and the bariatric surgical codes (CPT) to the insurance company. It is very important that the correct codes be used because these numerical codes may change every year and the insurance authorization may be delayed if the correct codes are not supplied to them. It is wise that the obese person considering the gastric bypass surgery or other form of weight loss surgery also ask for the codes that will be used so that they may speak more effectively with the insurance company's customer service agent when necessary. Furthermore, it is recommended that the surgical candidate also contact the primary physician's office and get additional codes to further support the claim for medical necessity.
It is customary that either the primary physician or the bariatric surgeon's staff work on getting further support of medical necessity. These supporting evaluations and letters from allied medical health professionals will corroborate the claim for medical necessity. Some examples of corroborating professionals may be other doctors who are caring for the obese person's weight associated medical conditions (or comorbidities), i.e. orthopedic, diabetic, psychiatric doctors. Also there are dieticians, psychologists, sleep professionals, physical therapists who may also contribute to the goal of achieving the medical necessity requirement.