In order to process the preauthorization for gastric bypass surgery, the Bellin Health Bariatric Program which includes Surgery Specialists of Green Bay require the following (please be aware this is not inclusive, as your insurance company or your medical history may require further tests, documentation, etc):
A letter of medical necessity from your primary care doctor is required indicating why they believe you may be an appropriate candidate for this surgery. If you don’t have a physician, we can assist you in locating one.
Psychological evaluation performed by our psychologist. If you already see a mental health professional, it is helpful to get their records for 3-6 months or ask them to write a letter on your behalf.
Documentation detailing all previous weight loss attempts within the past two years; Most insurances are requiring a documented 5-year history of obesity and documentation of a consecutive 3-12 month non-surgical weight loss program (if you don’t have this, we can assist you in meeting this criteria) The common required components of a required weight program are:
Monthly appointments with dietitian, personal trainer or exercise specialist, must be documented and consecutive
Availability of nutrition classes and support groups
Labs: TSH (thyroid test), Lipid panel, Hemoglobin A1C (if you are diabetic), Hpylori, Vitamin D-25 Hydroxy; Other labs may be required depending on your medical history. Note: if you have had these labs drawn elsewhere in the past 6 months, please bring a copy, as they may not need to be repeated.
Medical records for the past year
Copies or receipts of ANY diet attempts within the last 5 years
Letters or records from any physician or health professional that has advised you to lose weight
Copies of any tests you may have had in the past two years (EKG, stress test, echocardiogram, ultrasounds, x-rays, heart catheterization, any stomach test)
A gallbladder ultrasound is required of all patients unless it has been removed
An echocardiogram is required if you have taken Redux or Phen Phen in the past and or have a history of a heart murmur or other heart disease
A sleep study may be required.
You must identify a support person who will support you through all phases of this surgery and you must bring them with you to your initial appointment. If this is a problem for you, please contact us.
