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The process for bariatric surgery starts with the evaluation steps:
- Insurance issues
- Diet monitoring by your primary care physician (PCP)
- Dietitian consult
- Psychologist consult
- Screening blood tests
Most health insurance companies require that very specific guidelines be met for approval of bariatric surgery. We are committed to helping you meet these goals, but much is required from you, too. It is very important that you follow the guidelines in this section and keep all appointments as specified.
- Review your insurance company's coverage for bariatric surgery and what requirements must be met for reimbursement.
- The requirements change often and the companies do not always notify their clients, or us, until we submit for your coverage.
You and your primary care physician (PCP) will need to complete the following steps:
- Most insurance companies require that you follow an 800 - 1200 calorie/day diet supervised monthly by your PCP for at least 6 months.
- You should check in with your doctor and follow up with him/her every month so that your progress can be noted in your medical chart.
- Documentation of a 6-month diet requires 7 separate PCP office notes. The first note indicates the start of your diet.
- Patients must obtain 6 months of separate diet notes documenting an 800-1200 calorie/day diet.
- At the time that your surgery is scheduled, we will require a letter from your PCP stating that he/she has personally supervised a low-calorie diet (800-1200 calories/day) for the last 6 months, giving specific dates and what success, if any, you have had.
- This letter should be written/typed on the doctor’s official office letterhead.
- For your PCP’s convenience, we provide template letters and office notes.
- At each visit to your PCP, have your doctor fill out an office note. Have your PCP keep a copy, fax one to our office, and give you a copy as well.
- After we have received 5 months of notes, we can schedule a tentative date for surgery; however, we still need all of the notes before we can obtain authorization from your insurance company for gastric bypass surgery.
- Many insurance companies also need documentation of 5 years of patient weights. This can be fulfilled by obtaining an office note that has your weight on it – one per year for the past 5 years.
All patients are required to see our staff bariatric dietitians:
- They will evaluate you at your initial visit. This evaluation will cover your diet history and what you need to do to follow your 800-1200 calorie diet.
- It is important to understand the postoperative weight loss and diet expectations.
- Preoperative and postoperative dietary compliance are keys to long-term success.
- Some patients (usually those who weigh 450 pounds or more) may need a meal replacement plan program (Optifast) to help achieve more weight loss prior to surgery. Optifast is not usually covered by insurance & costs about $10 a day.
- At a subsequent follow-up visit, usually 2 weeks prior to your scheduled surgery, the dietitian will review the postoperative diet instructions.
All patients are required to be evaluated by a psychologist:
- At your first visit, you will schedule your evaluation at one of our offices.
- This evaluation will cover the realities and expectations of the surgery that have been discussed and allow him to determine if you are capable and competent to comply with the postoperative regimen and life-style changes.
- Patients who are seeing another psychiatrist or psychologist are still required to undergo comprehensive bariatric surgical evaluation by a West Penn Allegheny psychologist.
Blood tests are required by most insurance companies to evaluate for:
- Helicobacter pylori (H. pylori) – bacteria that cause stomach ulcers
- Thyroid stimulating hormone (TSH) – to test for hypothyroidism