Insurance Approval

What is medical necessity?

For most people, the actual process of convincing your insurance company to pay for the procedure is more frightening and more work than the procedure itself. While most insurance companies do pay for weight loss surgery, it may require a lengthy and complicated approval process.

When you call your insurance company to ask about coverage for the procedure, you will likely get an answer of "yes, based on medical necessity". The Bariatric team working with Dr Chung is very experienced in working with physicians, patients and insurers and they are aware of what it takes to gain approval from each and every insurance company. She will assist you as much as possible and guide you though this process, but it is ultimately up to you to prove to your insurance company that you qualify.

This requires you to gather chart notes documenting your health problems and diagnosis of morbid obesity as well as a letter of support from your primary care physician. If you follow the steps outlined, we do all the work for you and the process is relatively painless!

Here are some of the key steps you should take to obtain insurance coverage for weight loss surgery:


Ask about bariatric surgery (weight loss surgery) and if your policy has coverage for this type of service. Some policies will exclude weight loss treatment. Just because your friend with Blue Cross/Blue Shield was approved, that absolutely does not mean that your policy with Blue Cross/Blue Shield will allow it. EVERY POLICY IS DIFFERENT. Please do this prior to submitting your application!!


Before visiting the OSC office for your consultation, organize your medical records, including your history of dieting efforts. They will be valuable documents to have at every stage of the approval process. You should request copies of these records from physicians who have treated you in the past 2-3 years, depending on the specific requirements of your insurance company. These physicians also should be asked to write a letter of support for this procedure. All of this documentation is necessary for precertification with your insurance.


If it is determined that you are a candidate for surgery and that you have sufficient documentation, we will do the rest. First, we prepare a letter to obtain pre-authorization from your insurance company. The goal of this letter is to establish the "medical necessity" of weight loss surgery and gain approval for the procedure. The following information is generally included in the pre-authorization letter and you should bring these things with you to your first office visit.

  1. Your height, weight and Body Mass Index and any documentation you might have as to how long you have been overweight.
  2. Simply describing your condition as "morbid obesity" is not enough. A full description of all your obesity-related health conditions, including records of treatment, a history of medications taken and documentation of the effects these conditions have had on your everyday life is necessary.
  3. A detailed history of the results of your dieting efforts, including medically and non-medically supervised programs, records of meetings attended with commercial weight loss programs.
  4. A letter from your general physician(s) stating that he or she believes that you are a candidate for bariatric surgery and that you have the diagnosis of morbid obesity. It is also very important for your physician to state that he/she has supervised you in diet/exercise attempts that have not helped significantly.