Getting Started : Insurance Requirements

Insurance Requirements

A Letter of Medical Necessity and weight-loss history are necessary to obtain prior authorization for obesity surgery. A Letter of Medical Necessity states why significant weight loss is medically necessary for a patient and usually includes the following information.

  • Patient’s weight (BMI more than 40 or more than 35 with severe associated medical problems to qualify)
  • List of medical problems associated with obesity, such as type 2 diabetes, sleep apnea, hypertension, etc.
  • Number of years patient has been overweight (which should be at least five or more)
  • Documentation of failed weight-loss programs attempted for a minimum of 6 months in the past 2 years