First and foremost—contact your insurance company and find out “Do you cover bariatric surgery?”.

Then, find out if they cover the specific procedure that you are interested in having done—eg. Band, Bypass or Sleeve. This will give you an idea of coverage potential. It is ALWAYS a good idea to keep a record of who you spoke to and specify dates and times. If you have questions and/or concerns, it is also a good idea to e-mail or call our bariatric, insurance-approval specialist to find out the details of your coverage. Her e-mail is dolly@denverbariatrics.com. She can be called through our main number (303-280-0900) and you will be directed to her.

The information below is to be used by you and your primary physician to maximize your likelihood of a speedy and uncontested insurance approval. Copy this and bring it to your primary physician at your next appointment—the sooner the better! You can also click here to download and print a copy of this information. (Adobe Acrobat required).  Take this to your primary physician to help him/her facilitate your path to bariatric surgery pre-approval.

Important information that is now required for pre-approval for bariatric surgery through Aetna and Cigna: Cigna requires documentation of TWO (2), SIX (6) months’ duration, physician-supervised, weight loss attempts. And Aetna requires ONE (1) such program. Without this information, the approval process is impossible and will almost certainly be delayed up to 1 year! If the following information is not available, denials or delays always follow.

Here is how to best comply and help us with the pre-approval process. Begin this ASAP.

1. Go to your primary physician’s office and get weighed and make sure that they document your weight in your chart.
2. Have your physician recommend an exercise and/or diet regimen and document this recommendation in your chart.
3. Go back to your physician’s office at least every 4 weeks and weigh-in. Have them document your weight. Make sure this is recorded in your chart. At these evaluations, also have your physician note your progress and make recommendations as to how to proceed with improving your progress. DOCUMENTATION IS CRITICAL!! A full note must be written noting your progress and the recommendations given.
4. If the diet and/or exercise regimen is not effectively helping you lose weight, go see your physician again and have him/her recommend an alternative program.
5. Continue the weigh-ins.

If you have Cigna
After 6- months, go in and have your physician recommend an alternative regimen and, once again, document the whole process on a monthly basis.

Have copies of this record available when you come in to see Dr. Snyder.

If your physician has questions or concerns about this plan, please have him/her contact Dr. Snyder directly.

If this information is in hand at your consult with Dr. Snyder, the approval process (if you qualify for surgery) is usually quite easy. We will make every effort to expedite the process for you at this point.

How this is often done:

(Note: specifics diets mentioned are for the purposes of illustration only. They are not meant to be a guide for or suggestion of treatment options.)

For example, it would be great to have your physician recommend Jenny Craig for 6 months then The Zone for 6 months. Have him/her record the recommendations and your agreement to try them. DOCUMENTATION AT EVERY ENCOUNTER IS CRITICAL (!!) and will need to be available to present to your insurer. The more detail the better.

Make sure that there are visits during the interval of each diet regimen and weights recorded—monthly at least.

Then, make sure when you change to the new diet s/he records, for example, “Patient compliant with Jenny Craig diet for past 6 months and weight loss of XXXX. Inadequate weight loss/failure with this plan noted. Will attempt The Zone Diet starting today.”

Then continue the process for the second diet. For 6 months at least.

This is not a recipe for failure, although we must note the following. You may lose some weight, but it has been proven that for morbidly obese individual the “success” of traditional weight loss regimens is less than 5%. ALL of you have experienced this first hand already.

We hope that this memo will prevent the delays in the pre-approval process and the denials we have unfortunately seen in the recent past with Cigna and Aetna. Call if questions: 303-280-0900. We appreciate your help.

Also, feel free to e-mail our insurance specialist with your insurance plan particulars and she can find out what is covered and what you need to do to get ready. E-mail: dolly@denverbariatrics.com.

Michael A. Snyder, MD, FACS, PC