Elevate Your Practice with Bariatric Surgery Authorization Services

  • Dedicated Manager & Team
  • Verifications During Appointment Scheduling
  • Stringent QA and Standardized Workflows
  • Flexible Pricing with No Start-Up Fees or Long-term Contracts
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Verify Insurance Authorization for Bariatric Surgery and Optimize Billing

Verify Insurance Authorization for Bariatric Surgery and Optimize Billing

Navigating insurance coverage for bariatric surgery or weight loss surgery, a common treatment for obesity, can be complex. Despite its high cost, many health plans cover bariatric surgery when it is found to be medically necessary. We provide comprehensive bariatric surgery authorization services, keeping in mind the specific requirements of both Medicare and private insurance companies.

With efficient verification of coverage and benefits, our team ensures a smoother process for both you and your patients. We help reduce claim delays and denials, allowing your practice to focus on delivering quality care.

Our bariatric surgery prior authorization support includes:

  • Detailed insurance verification and benefit checks
  • Prior authorization request submission and follow-up
  • Coordination of medical necessity documentation
  • Appeals support for denied authorizations
  • Patient communication regarding benefit coverage
  • Ongoing updates to providers regarding authorization status
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Optimize verification and authorization process for bariatric surgery.

Optimize Your Revenue Cycle with Efficient Verifications and Authorizations

Our comprehensive insurance verifications and authorization for weight loss surgery are focused on maximizing your reimbursement. We ensure that patients receive the financial support they need to undergo life-changing procedures.

Insurance Verifications

We analyze patients’ insurance policies to determine coverage for their weight loss surgery. By clarifying pre-authorization requirements, deductibles, co-pays, and limitations, we help you price procedures and enable patients to understand their financial responsibilities.
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Pre-Authorizations

Obtaining the necessary pre-authorizations is a critical step in the insurance verification process for bariatric surgery. Our experts will work closely with insurance providers to secure timely pre-approvals, ensuring your claims are not denied due to lack of authorization.
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Insurers require detailed clinical documentation from healthcare providers before approving bariatric procedures. Our team ensures all supporting materials are collected, verified, and submitted properly, including:

  • Comprehensive medical history
  • Nutritional and psychological evaluations
  • Evidence of supervised weight loss programs (usually 3–6 months)
  • Letters of medical necessity from treating physicians
  • BMI reports and obesity-related co-morbidities
  • Operative plans and CPT code justifications

With our support, you can focus on delivering exceptional care, while patients can begin their weight loss journeys without the burden of insurance-related concerns.

Common Challenges in Bariatric Prior Authorization

Several obstacles frequently prevent healthcare providers from obtaining timely insurance authorization for bariatric procedures, including:

  • Variations in payer guidelines for covered procedures
  • Incomplete documentation or failure to meet pre-surgical criteria
  • Delays caused by non-compliant or missing referrals
  • Denials based on medical necessity or unsupported ICD-10 codes
  • Complex requirements for Medicaid plans that vary by state

Our team understands these concerns and works proactively with insurers to avoid unnecessary denials or delays.

Highlights of Our Insurance Verification Services

  • Dedicated team of insurance verification experts
  • Multi-level QA checks
  • Cost savings of 30-40%
  • Timely reporting based on your needs
  • HIPAA compliance
Highlights of Our Insurance Verification Services

Why Choose Us?

Expertise

Our team has extensive experience in medical billing and insurance verification for bariatric surgery. They are knowledgeable about the coverage policies across various insurance providers.

Live calls

Our live calls to the carrier helps obtain detailed and up-to-date coverage and benefits information. With immediate confirmation of coverage and pre-authorization for upcoming bariatric surgery, including complex procedures, you can provide timely care.

Open communication

Our verification specialists maintain open communication and rapport with insurance companies. This helps resolve any coverage challenges efficiently. It also helps you to provide patients with a clear explanation of their benefits and financial responsibilities in easy-to-understand terms.

We serve all 50 states

How Our Insurance Verification Process Works

The steps in our proven verification process are as follows:

1

Setting up an insurance file for each patient
2
Verification of Patient Benefits
3
Documenting all coverage details
4
Educating patients on costs of care
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Setting up an insurance file for each patient

A dedicated file is set up for each patient, making it easier to access and update patient insurance information as and when required.
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Verification of Patient Benefits

This process involves through checks to ensure that the patient’s insurance plan is active and covers bariatric surgery, potentially preventing claim processing issues.

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Documenting all coverage details

After confirming the patient’s insurance eligibility, we thoroughly document all coverage details in their file, including policy numbers, limits, co-pays, deductibles, and any applicable exclusions or limitations.
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Educating patients on costs of care

We educate patients about their coverage and treatment costs, empowering them to make informed decisions regarding their treatment options and understand their financial responsibilities. We also explain the claims submission and processing procedures, so that they are aware about the process works, with the aim to increase claim submission accuracy.

After submission, we closely monitor the authorization status, maintaining regular follow-up with payers to avoid processing delays and secure swift approvals. We also provide real-time updates to providers so scheduling and treatment plans stay on track.
OSI Learn More

Check out how we optimize eligibility verification and pre authorization process for healthcare providers to ensure timely approvals.

Pricing for Bariatric Surgery Insurance Verification

We offer different pricing options to meet the needs of bariatric surgery practices:

Full-Time Equivalent

In this model, services are billed based on the equivalent cost of a full-time employee (FTE) for a specified duration, usually monthly or annually.
Per Verification Billing
Like an FTE model, a person is dedicated to your practice. Perfect for a practice that is busy. They work as an extension to your business.
FTE/Per Verification Billing
This option is ideal for a practice that is unsure about their work requirements. This can have per request pricing for eligibility and other functions.

AR is only FTE

In this model, you will be charged a fixed monthly or annual fee based on the number of full-time equivalent staff required to manage your practice’s AR follow-up activities. We are also considering a blended model for AR.

Healthcare and Dental Revenue Cycle Management Process

Partner with us to navigate the complexities of insurance coverage effortlessly. We can scale to meet your verification needs!

FAQs

Why is insurance verification necessary for bariatric surgery?

Insurance verification is essential to determine the extent of coverage for bariatric surgery, including benefits, co-pays, deductibles, and any exclusions or limitations. It helps patients and healthcare providers understand the financial aspects of the procedure.

How long does the insurance verification process take?

The time taken for verification process can vary depending on several factors, such as the complexity of the insurance plan and the responsiveness of the insurance company. Our dedicated team is focused on completing the verification process as efficiently as possible.

Can insurance verification be done retroactively?

While best practice is to initiate insurance verification before the bariatric surgery process, it is sometimes possible to perform retroactive verification. However, it is important to note that retroactive verification may involve certain challenges and potential limitations.

How can outsourcing verification and authorization benefit my healthcare practice?

Partnering with a specialized verification and authorization company like ours can save you practice time and resources. It allows you to focus on providing quality care while ensuring that verification and authorization processes are handled efficiently and accurately.