by Susan Gallagher Camden, RN, MSN, WCON, PhD; and Anita Houle

Susan Gallagher Camden, PhD, RN, MA, MSN, CBN, is from the Celebration Institute, Inc., Houston, Texas; Anita Houle is Insurance Authorization Specialist, Cleveland Clinic Florida Bariatric Institute, Weston, Florida.

Introduction
In recent years, there has been a dramatic increase in the number of weight loss surgery (WLS) procedures performed in the US. Subsequently, WLS-related medical insurance claims have soared. This increased cost to third-party payers has led to increased scrutiny of WLS procedures. Regardless, more and more individuals are considering it a viable option. This increasing interest is likely because of the realistic promise that successful WLS is expected to help some people control comorbid conditions, engage in regular activities, and improve self esteem. However, not all candidates have resources to cover payment for such surgery. Additionally, there are candidates who have resources but are challenged in accessing them. This challenge is often rooted in the process of insurance approval. Read the rest of this article »

Dear Bariatric Times Editor:

On January 23, 2008, the headline on the front page of the New York Times read, “Diabetes Study Favors Surgery to Treat Obese.” With front page news stories in addition to television newscasts reporting the benefit of surgical procedures for the treatment of diabetes, it is logical to assume that the number candidates for these procedures will rapidly increase. Unfortunately, despite the impact of type II diabetes and the cost it imposes on our healthcare system, numerous barriers exist that make it difficult to obtain insurance pre-certification for coverage. Read the rest of this article »

by James W. Saxton, JD; Maggie M. Finkelstein, JD;
and Susan Gallagher Camden, RN, MSN, PhD

All from Stevens & Lee, Lawyers and Consultants Read the rest of this article »