Some policies require a clearance from your PCP (primary care provider) for bariatric surgery before they will approve your procedure. This means you will need a “History and Physical” from your PCP that also indicates you are medically cleared and are a good candidate to undergo weight loss surgery.
We cannot schedule surgery until a prior authorization approval is received, and we cannot obtain a prior authorization approval until ALL precertification criteria are completed and obtained. This means that if your carrier requires this, you will need to contact your PCP to schedule this appointment BEFORE we can even submit your authorization request for surgery and get us a copy of the documentation of the visit. This can be faxed to (513) 559-1235.
If we notify you that your policy requires this clearance, below is a list of carrier-specific requirements. If your carrier is not listed, you should just need a History and Physical with clearance.
Please Note: This is NOT the same as medical pre-operative clearance that may be requested within 30 days of surgery. We will let you know if and when it is time to schedule the second clearance visit with your PCP, if required.
Aetna:
- A History and Physical with clearance is required from your PCP. This must include a normal EKG and A1c within 3 months of submission.
Anthem:
A History and Physical with clearance is required from your PCP. This must specifically state that you are cleared for surgery.
Medical Mutual:
- A History and Physical with clearance is required from from your PCP. This must include:
- a normal EKG within 3 months of submission
- a normal hemoglobin A1C within 3 months of submission
In addition, if a comorbid condition is present, specialty clearance is required. For example, if you have a diagnosis of sleep apnea, you will have to get pulmonology (sleep doctor) clearance.
