Does the patient have a medical illness related to obesity and is he/she willing to participate in a pre-surgery weight loss effort to improve the success of surgery? (Even a somewhat slimmer patient has reduced cardiac risk.)

Can the patient make the lifestyle adjustment necessary to sustain weight loss? (Many of the dietary limitations are more severe than those needed to lose weight in the first place.)

Only by answering these questions, or using the expertise of your IRO, can you make an informed decision as to whether the claim is medically necessary or considered a cosmetic procedure.

About The Author

AllMed Healthcare Management Founded in 1995, AllMed (http://www.allmedmd.com, http://www.allmedmd.com/blog/index.htm) is a URAC-accredited Independent Review Organization (IRO) serving insurance payers, providers, TPAs and claims managers nationwide. Reviews are conducted by board-certified physicians in active practice. AllMed's growing customer base includes premier organizations, such as Educator's Mutual Life, IMS Managed Care, Tenet Healthcare Corporation, HealthGuard, several Blue Cross Blue Shield organizations, TriWest Healthcare Alliance, Allianz and many other leading healthcare payers.

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