OBJECTIVE: Adolescents seeking weight loss surgery (WLS) frequently encounter obstacles obtaining treatment authorization from insurance carriers. This study identified factors influencing authorization for adolescents with clinical indications for WLS. METHODS: A retrospective review was conducted for adolescents with clinical indications for WLS at five adolescent centers. This cohort represented a consecutive series of adolescents with insurance benefits for WLS for whom insurance authorization was sought between 2009 and 2011. Outcomes included number and timing of insurance authorizations for surgery, denials, and appeals. RESULTS: Records from 57 adolescents (74% female; mean age 16 (range: 12-17) years; mean BMI 51.3 kg/m(2) ) were reviewed. Of these, only 47% were approved with the original request. Eighty percent of those denied were approved on appeal, while 11% never obtained authorization for surgery. Age less than 18 years and proposed procedure were the most common reasons for denial. CONCLUSIONS: Less than half of adolescents with clinical indications for surgery received approval for the procedure on the first request. The appeal process typically resulted in overturning of denials, so that surgical care could be delivered.
OBJECTIVE: Adolescents seeking weight loss surgery (WLS) frequently encounter obstacles obtaining treatment authorization from insurance carriers. This study identified factors influencing authorization for adolescents with clinical indications for WLS. METHODS: A retrospective review was conducted for adolescents with clinical indications for WLS at five adolescent centers. This cohort represented a consecutive series of adolescents with insurance benefits for WLS for whom insurance authorization was sought between 2009 and 2011. Outcomes included number and timing of insurance authorizations for surgery, denials, and appeals. RESULTS: Records from 57 adolescents (74% female; mean age 16 (range: 12-17) years; mean BMI 51.3 kg/m(2) ) were reviewed. Of these, only 47% were approved with the original request. Eighty percent of those denied were approved on appeal, while 11% never obtained authorization for surgery. Age less than 18 years and proposed procedure were the most common reasons for denial. CONCLUSIONS: Less than half of adolescents with clinical indications for surgery received approval for the procedure on the first request. The appeal process typically resulted in overturning of denials, so that surgical care could be delivered.
Authors: Sarah B Cairo; Indrajit Majumdar; Aurora Pryor; Alan Posner; Carroll M Harmon; David H Rothstein Journal: Obes Surg Date: 2018-04 Impact factor: 4.129
Authors: J N Becnel; M H Zeller; J G Noll; D B Sarwer; J Reiter-Purtill; M Michalsky; J Peugh; F M Biro Journal: Pediatr Obes Date: 2016-05-30 Impact factor: 4.000
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Authors: Meg H Zeller; Jennie G Noll; David B Sarwer; Jennifer Reiter-Purtill; Dana L Rofey; Amy E Baughcum; James Peugh; Anita P Courcoulas; Marc P Michalsky; Todd M Jenkins; Jennifer N Becnel Journal: J Pediatr Psychol Date: 2015-03-15
Authors: Omar Nunez Lopez; Daniel C Jupiter; Fredrick J Bohanon; Ravi S Radhakrishnan; Kanika A Bowen-Jallow Journal: J Adolesc Health Date: 2017-09-01 Impact factor: 5.012
Authors: Meg H Zeller; Sanita Hunsaker; Carmen Mikhail; Jennifer Reiter-Purtill; Mary Beth McCullough; Beth Garland; Heather Austin; Gia Washington; Amy Baughcum; Dana Rofey; Kevin Smith Journal: Obesity (Silver Spring) Date: 2016-10-18 Impact factor: 5.002
Authors: Michelle I Cardel; Mark A Atkinson; Elsie M Taveras; Jens-Christian Holm; Aaron S Kelly Journal: JAMA Pediatr Date: 2020-06-01 Impact factor: 16.193