How to Refer
The Surgical Weight Loss Program for Teens at Cincinnati Children's Hospital Medical Center requires a letter of referral for weight loss surgery from your child's doctor. It is important that this referral specifically include your child's current weight, height and the doctor's assessment of any medical, physical or mental health problems that the overweight condition may have caused. We would also like for the doctor to include details of your child's:
General medical history
Prior treatments
Results of testing and weight loss attempts, including dieting records, that may be relevant to your child's
overweight condition
Once this information is received by our center, you will get a questionnaire packet to complete and return, along with a signed medical record release form and copy of your insurance card.
This information will be reviewed by our staff at the same time our Family Financial Advocate (FFA) is beginning to work with your insurance provider to obtain authorization for an evaluation visit. The medical staff reviews each case and determines whether surgery may be an option for your child at this time, or we may make other recommendations based on the information you and your child's doctor provide.
If our medical team suggests treatment other than surgery, a member of the team will contact you to discuss alternative available treatments.
If the medical team's review determines that weight loss surgery may be an option for your child, and we are able to obtain insurance authorization, we will contact you to schedule an evaluation visit and diagnostic tests.
In the event that your insurance denies the request, you may have appeal rights under the conditions within your insurance policy.
Bariatric Fast Track Referral Form
Before the questionnaire packet is sent out, the Surgical Weight Loss Program for Teens staff would like your child's primary care physician to complete and fax the Bariatric Fast Track Referral Form below.
You can download a copy of the Bariatric Fast Track Referral Form (219k) in portable document format (.pdf).
You must have Adobe Acrobat" Reader installed on your computer to read this file. You can download Adobe Acrobat" Reader at Adobe's Web site by selecting the version appropriate for your type of computer.
