Get the free Bariatric Surgery Authorization Request Form

Blue Cross Bluesier of Tennessee Bariatric Surgery Recertification Request Form The BCPST Medical Policy for Bariatric Surgery for Morbid Obesity can be found at http://www.bcbst.com/MPManual/Bariatric_Surgery.htm

How to fill out bariatric surgery authorization request

How to fill out bariatric surgery authorization request

1. Gather all necessary medical documents and supporting information required for the authorization request.
2. Fill out the patient's personal information, including name, date of birth, address, contact information, and insurance details.
3. Provide the patient's medical history, current diagnoses, and any relevant laboratory or imaging test results.
4. Include a detailed description of the patient's weight-related health conditions and previous attempts at weight loss.
5. Indicate the specific type of bariatric surgery being requested and provide a thorough explanation of why it is medically necessary for the patient.
6. Attach any additional supporting documentation, such as physician notes, referral letters, or psychological evaluations.
7. Submit the completed authorization request to the appropriate insurance company or healthcare provider.
8. Monitor the application process and follow up with the insurance company or healthcare provider as needed.
9. Once authorization is obtained, schedule the bariatric surgery procedure for the patient.

Who needs bariatric surgery authorization request?

1. Individuals who have a body mass index (BMI) of 40 or above may need bariatric surgery authorization request.
2. Individuals with a BMI between 35 and 39.9 who have serious weight-related health conditions, such as diabetes, heart disease, or sleep apnea, may also require bariatric surgery authorization request.
3. Candidates for bariatric surgery should have attempted other weight loss methods, including diet and exercise, without long-term success.
4. A healthcare professional, such as a surgeon or primary care physician, will determine if an individual meets the criteria for bariatric surgery and needs an authorization request.

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What is bariatric surgery authorization request?

A bariatric surgery authorization request is a formal application submitted to an insurance provider or health plan to obtain approval for coverage of weight loss surgery procedures.

Who is required to file bariatric surgery authorization request?

Typically, the healthcare provider performing the surgery or the patient seeking the procedure must file the authorization request to ensure that surgery expenses will be covered.

How to fill out bariatric surgery authorization request?

To fill out a bariatric surgery authorization request, the applicant needs to provide personal information, medical history, documentation of previous weight-loss attempts, and details about the recommended procedure.

What is the purpose of bariatric surgery authorization request?

The purpose of the bariatric surgery authorization request is to secure approval from insurers for the costs associated with the surgery to ensure that the patient receives financial coverage.

What information must be reported on bariatric surgery authorization request?

The request must include patient demographic information, medical history, treatment plans, evidence of obesity-related health conditions, and qualifications for surgery.