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  • Ga Sbhp Bariatric Surgery Requirements Form

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Georgia State Health Benefit Plan Bariatric Surgery Requirement Check List Coverage of Bariatric Surgery is available for eligible State Health Benefit Plan members with Primary SHBP coverage under the HRA and HDHP plan options only and is limited to ONE bariatric surgical procedure and course of treatment per lifetime. This lifetime limit also applies to any member who has undergone bariatric surgery in the past while covered under a previously .

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I feel this patient would benefit from weight loss surgery because (he/she) has been unsuccessful losing weight with other diet methods, and (his/her) medical conditions will become life-threatening if (he/she) does not get help getting (his/her) weight under control. I appreciate your consideration for approval.

Typically, the Letter of Medical Necessity will list the patient's BMI, how many years the patient has been morbidly obese, any participation in a medically supervised weight loss program, prior attempts at weight loss surgery and comorbidities (health problems associated with obesity).

To be eligible for weight-loss surgery, you must meet the following requirements: Have a body mass index (BMI) of 35 or higher, or have a BMI between 30 and 35 and an obesity-related condition, such as heart disease, diabetes, high blood pressure or severe sleep apnea.

The patient has a family history of weight-related ailments including [Medical conditions such as obesity, hypercholesterolemia, and diabetes.] I hereby request pre-authorization for bariatric surgery to include [Mr./Ms./Mrs.] [Patient Last Name's] policy benefits and coverage. Thank you for your consideration.

People with a Body Mass Index (BMI) of 40 or greater, or approximately 100 pounds over their ideal body weight. People who have a BMI between 35 and 40 and at least one significant obesity-related health condition, such as sleep apnea, diabetes or heart disease, may also be candidates for surgery.

Qualifications for Weight Loss Surgery You are more than 100 pounds overweight or have a body mass index (BMI) of 35 or more. ... Your health history includes obesity-associated conditions. ... You are between the age of 18 and 65 years old. ... You live a healthy lifestyle or are willing to adjust your lifestyle.

But why might a patient not qualify for bariatric surgery? BMI: First and most obviously, they simply may not have a BMI that is high enough. A BMI of 35 or more with one or more obesity related conditions or BMI of 40 or greater regardless of obesity related conditions is required to have surgery.

Weight loss surgery qualifies for Medicaid, Medicare, and most major insurance plans. Before scheduling your initial appointment, the office staff will check with your insurance carrier about the benefits coverage and the associated the weight loss surgery cost.

I feel this patient would benefit from weight loss surgery because (he/she) has been unsuccessful losing weight with other diet methods, and (his/her) medical conditions will become life-threatening if (he/she) does not get help getting (his/her) weight under control. I appreciate your consideration for approval.

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© Copyright 1997-2025
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3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232