Steps to Obtain Coverage
Documenting the Adverse Effects of Obesity
- Obesity poses risks during surgery: Wound complications, infections, blood clots, and mortality.
- Obesity-related comorbidities like diabetes and heart disease can worsen outcomes.
- Preoperative weight loss reduces risks and improves surgery success.
Understanding the Insurance Approval Process
- Meet eligibility criteria: BMI ≥ 40 or ≥ 35 with comorbidities; failed non-surgical attempts; medical and psychological suitability.
- Gather and submit medical records for review.
- Request pre-authorization from Fidelis Medicaid.
- Prepare for appeal if initial request is denied.
Navigating the Requirements
- Eligibility: BMI ≥ 35 with obesity-related comorbidity, failed non-surgical attempts, medical and psychological suitability.
- Approval Process: Gather documentation, submit for pre-authorization, and wait for coverage decision.
- Additional Considerations: Participation in programs, healthy lifestyle changes, and ongoing support.
Additional Tips for Success
- Explore prehabilitation programs: Improve pre-operative health.
- Consider surgical advancements: Explore less-invasive techniques.
- Focus on emotional support: Connect with support groups or therapists.
- Weigh benefits and risks: Ensure that potential benefits outweigh risks.
- Be patient with the approval process: Allow time for review of medical records and approvals.
Contact Information:
Fidelis Care Website 1-888-FIDELIS
Disclaimer: The information provided in this guide is for informational purposes only and should not be considered a substitute for medical advice. Always consult with a qualified healthcare professional for personalized guidance on weight loss surgery and eligibility requirements.