Step by Step Process in Getting Approved for Bariatric Surgery

Step by Step Process in Getting Approved for Bariatric Surgery

REFERRAL-Your doctor must call in a referral for you to our office. We obtain demographic information on you, including contact information, mailing address, and insurance information. At this point, our office verifies your insurance benefits to determine if your contract covers bariatric surgery or not. If your contract does not contain bariatric benefits, you will be notified in your welcome packet. You are mailed a welcome packet, which will include a date that you are scheduled for the informational seminar, instructions for writing a personal letter and diet history, seminar fee information, directions to the office, and a list of upcoming monthly support group meetings.

INFORMATIONAL SEMINAR-Once your doctor’s office has contacted the office, you are scheduled to attend an informational seminar. At the seminar, you will pay your seminar fee (an out-of-pocket expense for patient), complete your paperwork, and turn in your personal letter. You will also need to bring your insurance card(s) and I.D. along with your regular office visit co-pay (Dr. Mora falls under the specialist category if your insurance policy differentiates between a primary care and a specialist). You will also view a short video on the specific bariatric surgery you are planning to have and take a short quiz on information covered in the video. At the conclusion of the seminar, you will proceed to the consult with Dr. Mora.

OFFICE CONSULT - You will meet with Dr. Mora on an individual basis. He will do an evaluation on you. At this point, he will determine what tests and clearances you will need to have in order to complete your workup for your bariatric surgery. Our office will order most of the tests and will offer some phone numbers for you to call physicians to schedule those tests that we cannot order for you.

CLEARANCES- Dr. Mora will order some or all of the clearances below.

Six-month or 3-month (depending on your insurance policy), physician-monitored, weight loss program (you actually weigh in 7 for the 6-month requirement and 4 times for the three month requirement)

Psychiatric Clearance-we will offer you several numbers for area psychiatrists/psychologists, or with office approval, you may contact one of your own choosing.

Nutritionist Clearance

Cardiology Clearance

Pulmonary Clearance

Sleep Evaluation Clearance

Attendance at three monthly support group meetings prior to surgery (mandatory)

EGD-performed by Dr. Mora

SUBMISSION OF INFORMATION TO INSURANCE COMPANY-There will be no information submitted to your insurance company until you have completed the entire workup. The information will be faxed to your insurance company. Most insurances request that all the clinical information be faxed to them, which is the reason your predetermination is faxed rather than sent online. It usually takes anywhere from 5-10 days to receive approval for the surgery. After we receive your letter of approval, we will contact you to schedule your surgery. If you are a self pay patient, after completion of your workup, Dr. Mora will review your information, and we will schedule your surgery.

PREOP DIET-Prior to your surgery, you will need to be on a pre-op diet 4-6 weeks. The length of time on the pre-op diet depends on your BMI. You will have received a copy of this pre-op diet at either the informational seminar or the office consult. This diet consists of a protein shake for breakfast, a protein shake for lunch, and a low carb meal for dinner. Alterations to this diet can be made as needed, by Dr. Mora. Just contact our office if needed. You will need to begin your pre-op diet after you weigh in for the fifth time. If you have completed your 6 months of weigh-in prior to being referred to our office, you will need to start your pre-op diet the day after you attend the informational seminar and have your office consult. If your BMI is over 60, Dr. Mora requests that you begin the pre-op diet immediately.

SCHEDULE SURGERY-Once you have been approved and we have scheduled a date for your surgery, we will order your surgery with the hospital and obtain a pre-op appointment for you two weeks prior to your surgery. At your pre-op visit, you will meet with hospital inpatient registration and they will inform you of any fees you will have to pay the day of your surgery. Self-pay patients and patients with %50/50 coverage will need to pay fees to Dr. Mora on this day at the office. You will meet with the surgery team that will be working with you the day of your surgery and one of the nurses will get some more vital information from you. You will also meet with the anesthesiologist. The surgery team will also instruct you as to what time you will need to arrive at the hospital the day of the surgery and instruct you as to what medications you will take that day, and what medications you will need to bring with you to the hospital for after your surgery.

FINAL WEIGH-IN – After your pre-op with the hospital, you will need to stop in to our office for a final weigh-in prior to surgery.