Insurance Candidacy

Policy-Specific Requirements
Once Dr. Nowzaradan has established medical candidacy for surgery, our office must seek written approval for surgery from your insurance provider.

Often, we will know in advance of establishing your medical candidacy whether your policy covers bariatric (weight loss) surgery, and if so, what type(s) of surgery may be included in your policy. In order to most efficiently and accurately establish insurance candidacy, it is very important that you supply us with current, accurate insurance information. You may begin the process immediately by taking the time to complete our Patient Information Form included on our website. It is completely confidential. In strict accordance with the Health Information Privacy and Portability ACT (HIPPA), your personal and health information will not be shared with anyone not directly involved in the insurance approval and medical assessment process.

There are instances where the insurance company may require additional information from you and/or from our office, even if your policy technically covers you for weight loss surgery. As mentioned in the previous section of this website, Medical Candidacy, the National Institutes of Health have establish general guidelines that insurance companies are compelled to acknowledge when establishing a policy holder’s candidacy for weight loss surgery; however, there may be additional administrative requirements that are placed on policy qualifications.

Documentation and Collection
Employers typically determine the specific coverage within the policies offered their employees and, while individual discrimination is not legal, there may be specific requirements imposed for qualifying for a procedure.

Each insurance company may require differing amounts of documentation. We will assist you in acquiring and collecting yours. These may include:

  • Detailed diet history
  • Current height, weight and Body Mass Index (BMI)
  • List of co-morbid diseases that are, or may be related to your weight
  • A psychological evaluation or clearance
  • Thorough medical history
  • Internal Medicine clearance
  • Recent medically supervised diet history
  • Medical records documenting your history of morbid obesity
  • Additional medical tests

Because Dr. Nowzaradan has been specializing on bariatric surgery for over 20 years, he and his administrative staff are well-versed in the intricacies of managed care and the often painstaking process of inquiring about the specifics of an insured’s policy. We do the utmost to help you acquire the necessary supplemental documentation and medical tests, establish relevant health history, and secure the necessary additional information to help you gain approval or win an appeal for your surgery.