[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-1-en-105":3,"doc-seo-280291-105":53,"doc-detail-280291-en":127},{"code":4,"msg":5,"data":6},0,"success",[7,14,19,24,29,34,39,44,49],{"id":8,"doc_module":9,"doc_module_name":10,"category_name":11,"show_sort_weight":12,"slug":13},11,1,"Template","Presentations",90,"presentations",{"id":15,"doc_module":9,"doc_module_name":10,"category_name":16,"show_sort_weight":17,"slug":18},12,"Resumes",80,"resumes",{"id":20,"doc_module":9,"doc_module_name":10,"category_name":21,"show_sort_weight":22,"slug":23},14,"Invoices",70,"invoices",{"id":25,"doc_module":9,"doc_module_name":10,"category_name":26,"show_sort_weight":27,"slug":28},15,"Posters",60,"posters",{"id":30,"doc_module":9,"doc_module_name":10,"category_name":31,"show_sort_weight":32,"slug":33},16,"Social Media",50,"social-media",{"id":35,"doc_module":9,"doc_module_name":10,"category_name":36,"show_sort_weight":37,"slug":38},17,"Forms",40,"forms",{"id":40,"doc_module":9,"doc_module_name":10,"category_name":41,"show_sort_weight":42,"slug":43},18,"Letters",30,"letters",{"id":45,"doc_module":9,"doc_module_name":10,"category_name":46,"show_sort_weight":47,"slug":48},21,"Paper Templates",5,"papers-templates",{"id":50,"doc_module":9,"doc_module_name":10,"category_name":51,"show_sort_weight":4,"slug":52},158,"General","general-158",{"code":4,"msg":54,"data":55},"ok",{"site_id":56,"language":57,"slug":58,"title":59,"keywords":60,"description":61,"schema_data":62,"social_meta":120,"head_meta":122,"extra_data":124,"updated_unix":126},105,"en","insurance-approval-for-mbs-insurance-management-approvals-and-appeals-process","Insurance Approval for MBS - Insurance management - approvals and appeals process","","Insurance management for MBS focuses on selecting appropriate adolescent patients, confirming coverage status, and executing an approval workflow with complete documentation. The process emphasizes accurate BMI/percentile and comorbidity assessment, early initiation before program progression, and structured initial applications including surgeon, GI/nutrition, endocrine, and mental health visit records, testing, imaging, and labs. Outcomes include approvals with specific admission or EGD bundle options, requests for additional materials, and denials addressed through peer-to-peer review and appeals with supporting letters.",{"@graph":63,"@context":119},[64,80,102],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":41,"@type":70,"position":76},"https://docshare.wps.com/template/letters/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/insurance-approval-for-mbs-insurance-management-approvals-and-appeals-process/280291/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/insurance-approval-for-mbs-insurance-management-approvals-and-appeals-process/280291.png","ImageObject",442,249,{"name":88,"@type":89},"Jordan Avery","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-19","2026-09-16",true,{"@type":98,"interactionType":99,"userInteractionCount":101},"InteractionCounter",{"@type":100},"ViewAction",8,{"@type":103,"mainEntity":104},"FAQPage",[105,111,115],{"name":106,"@type":107,"acceptedAnswer":108},"What documentation is typically required for an initial MBS insurance approval application?","Question",{"text":109,"@type":110},"Submit visit dates for the surgeon, GI nutrition, endocrine, and psych teams, with cover-sheet timing, letters from required clinicians, all visit notes, all testing, all imaging, and all labs. Supplemental items may be added depending on payer requests.","Answer",{"name":112,"@type":107,"acceptedAnswer":113},"How should clinicians determine whether the patient qualifies for coverage before starting the program?",{"text":114,"@type":110},"Use BMI and/or 95th percentile measurements, review comorbid conditions, confirm the insured’s policy criteria, and determine whether MBS is covered or carved out. Raise coverage questions early to avoid delayed progression.",{"name":116,"@type":107,"acceptedAnswer":117},"What steps are recommended when the initial application is denied?",{"text":118,"@type":110},"Expect written denial and family follow-up, request peer-to-peer review, and prepare to rebut the denial using evidence. Use the faxed record with the EMR open, identify denial reasons from the letter, and consider specialty-specific or outside peer reviewers.","https://schema.org",{"og:url":78,"og:type":121,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":123,"canonical":78},"index,follow",{"doc_id":125,"site_id":56},280291,1790133300,{"code":4,"msg":5,"data":128},{"doc_id":125,"user_id":129,"nickname":88,"user_avatar":130,"doc_module":9,"category_id":40,"category_name":41,"doc_title":59,"doc_description":61,"doc_content":131,"file_id":132,"file_url":133,"file_type":134,"file_size":135,"view_count":101,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":136,"language":137,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":138,"faqs":139,"seo_title":140,"seo_description":61,"update_tm":141,"read_time":47},1099523882367,"https://ap-avatar.wpscdn.com/davatar_9964176cb1d06d4a9deccf72a44ae3dc","Insurance Approval for MBS  \nJeff Zitsman, MD  \nMSCHONYP  \nAPSA AMS Committee Monthly meeting  \n10 Sept 24  \nNo financial disclosures  \nInsurance management  \n• Picking the appropriate patient  \n• Best shot first  \n• Appeals & beyond  \nINSURANCE PAYMENT FOR ADOLESCENT LAPAROSCOPIC GASTRIC BANDING--IT ISN’T EASY BECOMING LEAN  \n• 105 consecutive adolescents for LAGB  \n• Specialist letters, labs, studies  \n• Visit documentation  \n• 44 approved (42%)  \n• 40 Additional material requested  \n• Additional testing 6  \n• Case letters 16  \n• 32 more approved (68%)  \n• Additional letters, Peer-to-peer, letter from lawyer; 1 self-pay  \n• 24 more approved (96%)  \n• 2 denied  \n• 2 found that insurance did not cover MBS  \nZitsman, JL. Presented at ASMBS Obesity Week, 2010  \nPicking the appropriate patient  \n• BMI and/or 95th %ile measurements  \n• Comorbid conditions  \n• Criteria of the policy of the insured  \n• Is MBS covered? Has it been carved out?  \n• Bring this up EARLY before the patient progresses through the program!  \n• What evaluations are needed?  \nInitial application for approval  \n• Docs faxed to insurance (90-200+)  \n• Dates of visits (surgeon, GI nutrition, endocrine, psych)  \n• Cover sheet table of dates of visits  \n• Letters from surgeon, medical director, mental health evaluator, nutritionist  \n• All visit notes from the above  \n• All testing  \n• All imaging  \n• All labs  \n• Possibly supplemental letter from LMD  \nInitial application for approval  \n• Keep record of receipt  \n• Keep packet together until approved  \n• Allow a MINIMUM of 2 weeks (may be • shorter if > 18 yr)  \n• Call after 1 week for status update  \n• IF URGENT, call first and speak to  \n• nurse manager  \nInitial application outcome  \n• Surgery approved:  \n• Written (printed) denial sent to family/facility/surgeon  \n• Surgery approved but EGD part of the bundle  \n• Surgery approved as 23-hr admit  \n• Accept and document need to stay longer if applicable (e.g., inadequate PO intake, pain)  \n• Request for additional document (e.g., medical director letter, nutrition visits, drug screen)—usually has been part of package sent  \n• Request for repeat of remote testing (1 yr)--rare  \nInitial application denied  \n• Written (printed) denial sent to family/facility/surgeon  \n• Expect family to contact you, upset  \n• Be confident; advised that there will be more work to be done  \n• Peer to peer  \n• Have the faxed record with you  \n• Have the EMR open  \n• The reviewer is not the enemy. They are matching what they see with their criteria for approval  \n• If you can identify the reason(s) for denial from the letter sent, be prepared to rebut them with evidence  \n• Example: no documentation of 6 months consecutive visits (help them find it)  \nInitial application denied  \n• Peer review does not approve-  \n• You can ask for a specialty specific peer reviewer, e.g., a bariatric and metabolic surgeon  \n• You can ask for an outside specialty reviewer  \n• Family initiated appeal  \n• Sometimes required by the policy. You can guide them  \n• Obtain additional support from the pediatrician  \n• Letter from you indicating that insurance company is denying standard acceptable medical and surgical care in your expert opinion. Include literature (ASMBS guidelines, AAP GCP summary)","cbCain7b6WyUamBm","https://ap.wps.com/l/cbCain7b6WyUamBm","pdf",297723,13,"English","# Insurance Approval for MBS\n## Insurance management\n## Insurance payment for adolescent laparoscopic gastric banding\n## Picking the appropriate patient\n## Initial application for approval\n## Initial application outcome\n## Initial application denied\n## Peer review and appeals","[{\"question\":\"What documentation is typically required for an initial MBS insurance approval application?\",\"answer\":\"Submit visit dates for the surgeon, GI nutrition, endocrine, and psych teams, with cover-sheet timing, letters from required clinicians, all visit notes, all testing, all imaging, and all labs. Supplemental items may be added depending on payer requests.\"},{\"question\":\"How should clinicians determine whether the patient qualifies for coverage before starting the program?\",\"answer\":\"Use BMI and/or 95th percentile measurements, review comorbid conditions, confirm the insured’s policy criteria, and determine whether MBS is covered or carved out. Raise coverage questions early to avoid delayed progression.\"},{\"question\":\"What steps are recommended when the initial application is denied?\",\"answer\":\"Expect written denial and family follow-up, request peer-to-peer review, and prepare to rebut the denial using evidence. Use the faxed record with the EMR open, identify denial reasons from the letter, and consider specialty-specific or outside peer reviewers.\"}]","Insurance Approval for MBS - Insurance management - approvals and appeals process | PDF",1789536458]