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Bariatric Surgery Predetermination Request Form - BlueCross

Bariatric Surgery Predetermination Request Form - BlueCross 2025

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The document is a comprehensive Patient History Questionnaire for individuals seeking bariatric surgery at Mercy Medical Center. It collects detailed personal, medical, and family history information, including consent for communication, insurance details, weight history, dietary attempts, exercise habits, and various health conditions. The questionnaire aims to ensure thorough understanding of the patient's health status to facilitate appropriate care and insurance approval for surgical procedures.

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

How do I get my BCBS to cover bariatric surgery?

Your best bet is to call the insurance (you should be able to look this up online) and give them your info (usually they need your name, birthdate, and contract number) and ask them what the requirements for bariatric surgery are, if they have a monthly supervised weight loss requirement, etc.

What is a prior authorization for BCBS Illinois?

There are different ways to initiate your request. Online Use BlueApprovRSM to request prior authorization for some services. Online Registered Availity users may use Availitys Authorizations tool (HIPAA-standard 278 transaction). By phone Call the prior authorization number on the members ID card.

What is a predetermination form?

A predetermination is a voluntary, written request by a member or a provider to determine if a proposed treatment or service is covered under a patients health benefit plan.

How long does it take BCBS to approve bariatric surgery?

Most of the time, people who work through the required testing and obtain the necessary education may be able to request approval for bariatric surgery. However, it can take several weeks, usually around three weeks, to receive approval for the procedure.

What does it mean when insurance needs prior authorization?

If you want to know more about this process or how decisions are made about your care, contact Member Services at 1-877-860-2837 (TTY/TDD: 711). Use our Provider Finder to search for doctors and other providers.