Get the free Bariatric Surgery Precertification Request Form - BlueCross ...

FOR OFFICE USE ONLY UCSF BARIATRIC SURGERY CENTER NEW PATIENT MEDICAL HISTORY QUESTIONNAIRE UNIT NUMBER PT NAME BIRTHDATE Please complete this form to provide information regarding your medical condition.

How to fill out bariatric surgery precertification request

How to fill out a bariatric surgery precertification request:

1. Start by obtaining the precertification request form from your insurance provider. This form is usually available on their website or can be requested by calling their customer service.
2. Fill out your personal information accurately on the form. This may include your name, address, contact information, policy number, and the date of the request.
3. Provide your healthcare provider's information, including their name, address, and contact details. Make sure to include any special instructions or requirements given by your healthcare provider, such as attaching medical records or specific test results.
4. Indicate the type of bariatric surgery you are seeking precertification for. This may include gastric bypass, gastric sleeve, or lap band surgery. Provide any additional details if necessary, such as the planned surgery date or any previous weight loss efforts.
5. Include any relevant medical documentation that supports the need for bariatric surgery. This can include medical records, previous doctor's notes, or test results. Make sure to attach these documents securely to prevent them from getting lost or separated.
6. Review the form thoroughly before submitting it. Double-check for any missing or incorrect information. It is crucial to be accurate and complete when filling out the form, as any errors or missing information can delay the precertification process.
7. Once you are confident that the form is complete, submit it to your insurance provider through the specified method. This may include mailing it, faxing it, or submitting it online through their portal. Make sure to keep a copy of the form for your records.
8. After submitting the precertification request, you will need to wait for a response from your insurance provider. The processing time can vary, but it is advisable to follow up with them after a reasonable period to ensure that your request is being reviewed.

Who needs a bariatric surgery precertification request:

1. Individuals who are planning to undergo bariatric surgery and have insurance coverage for this procedure will likely need to submit a precertification request.
2. Insurance providers typically require precertification to ensure that the bariatric surgery is medically necessary and fits within the terms of the policy.
3. It is essential to check with your specific insurance provider to determine their requirements for precertification and to confirm whether it is necessary in your situation. This can be done by reviewing your insurance policy documents or contacting your insurance provider directly.

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What is bariatric surgery precertification request?

Bariatric surgery precertification request is a formal process used to obtain approval from a health insurance provider before undergoing bariatric surgery.

Who is required to file bariatric surgery precertification request?

Patients who are considering bariatric surgery are required to file a precertification request with their health insurance provider.

How to fill out bariatric surgery precertification request?

To fill out a bariatric surgery precertification request, patients need to provide detailed information about their medical history, weight loss efforts, and the bariatric surgery procedure they are planning to undergo.

What is the purpose of bariatric surgery precertification request?

The purpose of a bariatric surgery precertification request is to obtain approval from the health insurance provider, ensure that the surgery is medically necessary, and determine coverage and benefits.

What information must be reported on bariatric surgery precertification request?

Information such as medical history, weight loss efforts, documentation from healthcare providers, and details about the bariatric surgery procedure must be reported on the precertification request.