Unlike many other types of surgery, bariatric operations must be authorized by the insurance company before they will pay anything on behalf of the patient. Most insurance plans have developed criteria for authorization. These criteria might include: proof in the medical record that a person has been morbidly obese for a certain period of time, demonstration of associated co-morbid conditions caused by obesity, documentation that a patient has failed a physician supervised diet for a specified number of months, a psychological evaluation, and a medical evaluation, among others. These criteria differ between insurance companies and even between individual plans sold by the same company. The patient must show proof to the insurance company that these criteria have been met to receive authorization.
Doctor Marvin has been fortunate to have several members of his medical staff who are experienced and knowledgeable in the process outlined above. They are the Bariatric Case Managers. They will assist and guide the patient in both obtaining insurance authorization for the surgery, and in completing the steps in the pre-operative medical assessment necessary to make the surgery as safe as possible (see section on pre-op medical assessment).
IMPORTANT: The Case Managers are there to ASSIST the patient in this process. They did not create the criteria necessary for authorization. They cannot change the rules. And they certainly are not responsible for decisions or delays caused by the insurance company. This is often a frustrating process – please remember the Bariatric Case Manager is on your side – and avoid venting any negative feelings towards her.
The Bariatric Case managers for Doctor Marvin are:
