Insurance Plan Requirements

mbs wellness insurance verification

Written By: Angie McShan – Financial Specialist

Each insurance company has a unique set of requirements that must be met by the patient before a predetermination or precertification can be requested by the provider.  These guidelines are specifically put into place for the patient to complete and show the insurance company their commitment to being successful with their upcoming bariatric surgery. 

Here are just some of the requirements that may be required, depending on your specific insurance policy:

  • BMI 35 – 40 (Height and Weight Ratio)
  • Comorbidities (Health Issues) like
    • Obstructive Sleep Apnea,
    • High Blood Pressure,
    • Diabetes
  • Or no comorbidity if BMI >40 (or number determined by the insurance plan)
  • 3-12 Month Diet
  • Nutritional Evaluation or “1-time diet”
  • Psychological Evaluation
  • Documentation of Weight History
  • Labs like TSH (thyroid to rule out metabolic cause of obesity)

These “policy guidelines” do differ from insurance to insurance.  Do not get defeated when you see these requirements.  My Bariatric Solutions (MBS) is here to walk you through each one to help you be successful in your journey. 

Once all requirements are completed, MBS will submit for predetermination or precertification to your insurance company with the medical records for surgery approval.   

Please note – that a Bariatric Exclusion means that your insurance company (or purchaser of your plan such as your employer) has opted to exclude bariatric surgery as a covered benefit.  There is no one that can overturn the exclusion or bypass it when submitting the claim for approval.  My Bariatric Solutions strives to over competitive cash pricing for the Gastric Sleeve, Gastric Bypass, and Orbera Balloon so please give us a call to discuss.