Checklist for insurance approval

The following is a checklist to ensure that you have the necessary information to have your surgery approved by CHRISTUS Santa Rosa Health System


Benefits
Check your benefits. Call the customer service number at your insurance company, and ask for the benefits department. Ask if you have benefits for bariatric surgery. This information can also be found written in your policy on the exclusions page.

You may be asked for CPT Codes, which are:
Lap Banding   43770
Sleeve Gastrectomy     43775
Gastric Bypass      43644

Surgical Clearance
Each patient is required to have a physical with their primary care physician within the six months prior to surgery. This exam is used to determine that a patient does not have any underlying medical conditions that would prohibit them from having surgery. A letter/copy of the exam notes needs to be sent to our office prior to scheduling an appointment.

Pre-operative Lab Work
Each patient will be asked to have labwork completed, with a copy of your results sent to our office prior to your initial consultation.

Diet Records
You will be asked to provide documentation of all recent medically supervised weight loss attempts. The insurance company may deny benefits if you don't provide proof that you have tried physician-supervised weight loss attempts. Be sure to have several visits with your primary care physician over a six-month period documenting your progress. The weight loss attempts do not have to involve medication. They may include exercise, low calorie diets, etc.

Medical Records
Medical records are essential to establishing medical necessity. Any visits to a doctor, surgeries, lab results, diagnostic procedures and ER visits should be included. Request records pertaining to your weight and any conditions worsened by your weight, such as hypertension, diabetes, degenerative joint disease, etc.  We need records dating back five years, unless insurance indicates a need for more.

Psychological Evaluation
A preoperative psychological evaluation is an essential part of preparing for weight loss surgery. The importance of obtaining a thorough psychological assessment cannot be overstated. A detailed clinical interview and objectively scored psychological tests should be part of a comprehensive psychological evaluation. Many insurance companies require an evaluation for benefits and our surgeons require an evaluation for all patients.