OUR PROGRAM

Getting started ::
This page is designed to guide you through the steps that need to be taken prior to having surgery

1. Determine Your Candidacy
a. You have a Body Mass Index (BMI) of over 40.
b. You have a BMI of over 35 and are experiencing Obesity-related health conditions,
such as high blood pressure or diabetes.
c. You are unable to achieve a healthy body weight for a sustained period of time, even through medically supervised dieting.

2. Verify Coverage by your Insurance Company
We require that all patients call the 1-800 number on the back of their insurance card and check to make sure the Gastric Bypass is a covered benefit under their plan. We do ask that you do this before you contact us to make your appointments.

3. Complete patient questionnaire and mail to Peachtree Surgical Specialists 285 Boulevard, NE, Suite 440, Atlanta, GA 30312 or fax to our office (404) 523-2422 along with a copy of your insurance card.
Upon receipt of the questionnaire; the office will contact you to arrange your initial consultation.



4. Get a valid referral from your Primary Care Physician

5. Make Your Appointments
During your consultation with Dr. Hixon, he will discuss and clarify your medical history, conduct a brief physical examination, and determine from a medical standpoint if you are a good candidate for weight loss surgery. If you are a candidate, he will discuss with you the benefits, expected outcomes, risks, and complications of the different procedures. He will also review preoperative vitamins, minerals, protein supplements, and exercise. He will also discuss issues such as time off from work, getting back to work, support from family and friends, emotional and psychological changes, and the patient support groups and classes available to you. Write down any questions that come to mind so that your concerns can be addressed at the time of this visit.

6. Insurance Authorization

This office and most insurance companies require the following evaluations before we can submit a pre-certification request :

  Psychological evaluation
  Dietician/nutritional evaluation
  letter of medical necessity from your primary physician

7. Scheduling For Surgery
Once we obtain approval for surgery from your insurance carrier, our office will contact you to schedule a surgery date.
 
8. Pre-operative Testing

Diagnostic Tests and Preoperative Clearances. Once we have obtained precertification from your insurance company; you will also be scheduled for your preoperative classes, labs, and exams. The following preoperative tests are required.

  Cardiology evaluation
  Pulmonary evaluation
  Gallbladder ultrasound
  Lab work


9. Pre-Admission Testing (PAT).
The process through which all scheduled surgery patients will register; have nursing assessment done, and Anesthesia consultation, (usually done within 7 days of scheduled surgery).

10. Post-Op Instructions



Financial info ::
Paying for Your Weight Loss Surgery:
At some point, after you have spent a considerable amount of time exploring the option of weight loss surgery, you will need to determine how to pay for the surgical procedure. A growing number of states have passed legislation that requires insurance companies to provide benefits for weight loss surgery for patients that meet the National Institutes of Health surgical criteria. And while insurance coverage for weight loss surgery is widespread, it often requires a lengthy and complicated approval process. The best chance for obtaining approval for insurance coverage comes from working together with your bariatric surgeon and other experts.
 
Here are some of the key steps you should take to obtain insurance coverage for weight loss surgery:

Read and understand the "certificate of coverage" that your insurance company is required by law to give you. If you do not have one, consult your company's benefits administrator or ask your insurance company directly.

You may be required to start with your primary care physician. In some cases, he or she is the only one you can ask for a referral to a qualified bariatric surgeon. Even if you are not required to get a referral, it is a good idea to have the support of your primary care physician.

Before visiting the bariatric surgeon, organize your medical records, including your history of dieting efforts. They will be valuable documents to have at every stage of the approval process.

Document every visit you make to a healthcare professional for obesity-related issues or visits to supervised weight loss programs. Document "other" weight loss attempts made through diet centers and fitness club memberships. Keep good records, including receipts.

If your bariatric surgeon recommends weight loss surgery, he or she will prepare a letter to obtain pre-authorization from your insurance company. The goal of this letter is to establish the "medical necessity" of weight loss surgery and gain approval for the procedure. The following information is generally included in the pre-authorization letter:

1. Your height, weight and Body Mass Index and any documentation you might have as to how long you have been overweight.

2. Simply describing your condition as "morbid obesity" is not enough. A full description of all your obesity-related health conditions, including records of treatment, a history of medications taken and documentation of the effects these conditions have had on your everyday life is necessary.

3. A detailed description of the limitations your excess weight places on your daily activities, such as walking, tying shoes, or maintaining personal hygiene.

4. A detailed history of the results of your dieting efforts, including medically and non-medically supervised programs, medical records and records kept of payments to and meetings attended with commercial weight loss programs.

5. A history of exercise programs, including receipts for memberships in health clubs.

6. Ask your doctor to include information from medical journals regarding the effectiveness of weight loss surgery, particularly information showing the control or elimination of obesity-related health conditions.

Thirty days is the standard time for an insurance provider to respond to your request. You should initiate a follow-up if you have not heard from your insurance company in that time.