Candidate Screening — quick readiness check

• What is your current BMI (or the BMI of the person you are referring)? Options: <35 (below typical surgical criteria), 35.0–39.9, 40.0–49.9, 50.0 or higher, Unknown / prefer not to say
• Which obesity-related conditions apply to you or the person you're referring? Options: Type 2 diabetes, Hypertension, Obstructive sleep apnea, Nonalcoholic fatty liver disease (NAFLD/NASH), Hyperlipidemia, Osteoarthritis / joint disease, None of the above, Other (please list)
• Have you or the person been through supervised medical weight-loss programs or anti-obesity medication under clinician oversight? Options: Yes — multiple documented supervised programs (behavioral, medications, or both), Yes — one documented supervised program, No — no documented supervised attempts, Prefer not to say
• What best describes your (or the patient's) insurance or payment approach for bariatric surgery right now? Options: Private insurance with known bariatric coverage, Private insurance — likely no coverage or unknown, Medicare, Medicaid / state plan, Employer-sponsored benefit pending approval, Self-pay / willing to finance, Unknown
• When are you hoping to proceed with a full clinical evaluation or surgery? Options: Within 1–3 months, 3–6 months, 6–12 months, No firm timeline — exploring options, Only after insurance pre-authorization is confirmed

Decision Authority & next step

• Who will make the final decision to proceed with evaluation and surgery (you, a family member, referring clinician, or an insurer/employer)? Options: You (the patient) alone, You + partner or family caregiver, Referring clinician / primary care must approve, Insurance or employer approval required, Undecided / multiple stakeholders
• Is there anything else we should know before scheduling a full clinical discovery (recent clearances, active conditions, medication concerns, or scheduling constraints)?

A Quick Health Snapshot

• Tell me in one sentence why you are exploring surgical weight-loss right now.
• How long have you been considering bariatric surgery? Options: Less than 1 month, 1-3 months, 3-6 months, 6-12 months, More than 1 year
• Provide your current BMI or an approximate if you do not know the exact number.
• Which of these obesity-related conditions apply to you today? Options: Type 2 diabetes, Hypertension, Obstructive sleep apnea, Gastroesophageal reflux disease, Nonalcoholic fatty liver disease, Osteoarthritis, Depression or anxiety, Other
• Have you completed supervised medical weight-loss programs in the past, for example a program with a dietitian or medical clinic? Options: Yes, multiple programs, Yes, one program, No
• When was your last supervised weight-loss attempt and what was the clinical outcome?

Where the Medical Reality Breaks Expectations

• If a single medical finding in your history would make us stop the surgical pathway today, which one would it be?
• List any prior abdominal or bariatric surgeries and the approximate dates for each.
• Which medications that you take today affect weight, appetite, or metabolism? Options: Insulin, GLP-1 or incretin therapy, SGLT2 inhibitors, Antidepressants, Antipsychotics, Corticosteroids, Weight-loss medications, None of the above, Other
• How well controlled are your chronic conditions, for example typical A1c, blood pressure range, or recent sleep study results?
• Is there an active cardiac, pulmonary, or psychiatric issue that would prevent surgery within the next 6 months? Options: Yes, No, Not sure

The Everyday Rules That Will Decide Success

• Describe daily routines or household constraints that would make post-operative diet and activity plans impractical for you.
• Who prepares most of the meals in your home and how open is that person to changing recipes or meal timing? Options: I prepare meals, Partner/spouse, Parent or other family member, Care facility or caregiver, Other
• How many hours per week can you realistically commit to follow-up visits, nutrition counseling, and program check-ins? Options: 0-2 hours, 3-5 hours, 6-10 hours, 10+ hours
• Describe any mobility limits, work obligations, or caregiving duties that would affect your recovery timeline.
• If you could not follow the post-operative protein and supplementation plan perfectly, would you still want to proceed? Options: Yes, I would proceed, No, I would pause, I need more information

Who Needs to Be Included for This to Work

• Name the people who will sign off on this decision or whose permission matters most to you. Options: I decide alone, Partner or spouse, Parent or guardian, Primary care physician, Employer or insurance representative, Shared decision
• List the clinicians who must be involved for pre-operative clearance, for example cardiology or endocrinology. Options: Primary care provider, Endocrinologist, Cardiologist, Pulmonologist, Psychiatrist or psychologist, Sleep specialist, Other
• Has anyone in your immediate family had bariatric surgery, and if so what was their outcome?
• Who will handle logistics for the first two weeks after surgery, such as meal prep, transportation, and wound care? Options: Partner or spouse, Family member, Friend, Professional caregiver, I will manage myself, Other
• Would anyone in your circle be able to veto the surgery if you decide to move forward? Options: Yes, No, Not sure

How We'll Measure Whether This Worked for You

• Which single outcome would make you feel the surgery was a success, for example percent weight loss, diabetes remission, or stopping medications? Options: Sustained percent weight loss, Type 2 diabetes remission or major A1c drop, Reduction or elimination of medications, Improved sleep or reduced OSA, Improved mobility or less joint pain, Improved mental health or quality of life, Other
• How soon would you expect to see meaningful clinical improvement before you judge the program, for example 3, 6, or 12 months? Options: 3 months, 6 months, 12 months, 24 months
• How do you prefer to track progress after surgery, for example clinic visits, remote weigh-ins, lab monitoring, or an app? Options: In-person clinic visits, Remote weigh-ins and telehealth, Structured app or portal, Home lab draws with clinic review, Combination, Other
• Name any side effects or outcomes that would be unacceptable enough for you to stop the pathway.
• Would a 30% total weight loss at 12 months meet your primary goals? Options: Yes, No, Unsure

Risks, Insurance Hurdles, and What Could Kill the Plan

• Name the insurance or authorization result that would cause you to walk away from surgery entirely. Options: Denial of surgical coverage, Only partial coverage with unaffordable out-of-pocket, A required multi-month pre-authorization program, Delay beyond 6 months, Other
• Select which financial arrangements you would accept to proceed. Options: Full insurance coverage, Payment plan through clinic, Self-pay upfront, Only proceed with full insurance approval, Other
• Have you ever been denied bariatric surgery by an insurer, and if so what was the reason provided? Options: Yes, did not meet medical criteria, Yes, insufficient documentation, Yes, prior authorization denied for other reasons, No, Not sure
• Choose the surgical complications that worry you most when you picture the post-operative period. Options: Anastomotic leak or need for reoperation, Nutritional deficiencies, Surgical infection, Hospital readmission, Long-term gastrointestinal symptoms, Death, Other
• How would a 3 to 6 month delay in timing affect your medical condition or willingness to proceed?

Alternatives You're Seriously Considering

• Imagine surgery were not available, what would you do next to manage your weight and related conditions?
• Select the non-surgical approaches you have tried or are evaluating now. Options: Prescription weight-loss medication like GLP-1s, Other anti-obesity medications, Intensive medical weight-loss program with dietitian, Endoscopic weight-loss procedures, Meal replacement programs, Commercial weight-loss program, None of the above
• Which current provider or program would you most likely remain with if you decide against surgery? Options: Primary care-led medical weight loss, Endocrinology-led program, Commercial program, Employer wellness program, Do it myself, Other
• Name the one change to your current non-surgical approach that would make you cancel plans for surgery.
• Has anyone suggested handling this internally, for example your primary care clinician proposing advanced medication management or your employer offering benefits? Options: Yes, PCP proposed medical management, Yes, employer is arranging benefits, No internal solution proposed, Other

Practical Readiness: Clearances, Records, and Timeline

• If required clinical records cannot be produced within 4 weeks, would that stop scheduling or are you able to accept a longer timeline? Options: Stop scheduling, cannot proceed, Accept a longer timeline, Not sure
• Which of these required items do you already have available from the last 12 months? Options: Recent labs (CBC, CMP), A1c within 3 months, Cardiac clearance or recent EKG, Pulmonary function or sleep study, Psychological evaluation, Abdominal imaging, Pre-op nutrition plan from a dietitian, None of the above
• Who controls access to your medical records and can provide them when requested? Options: I control and can release records, My primary care provider will release them, A specialist will release them, Medical records department of a clinic/hospital, Not sure
• Does your insurance require documented failed supervised weight loss for a defined duration, and can you supply that documentation? Options: Yes, and I can supply proof, Yes, but I cannot supply proof, No, there is no such requirement, Not sure
• Do you have any planned life events in the next 6 months such as pregnancy, extended travel, or major work obligations that would block surgery? Options: Planned pregnancy or trying to conceive, Extended travel or relocation, Work leave limitations, Major surgery scheduled, None of the above, Other
• Will other providers need to coordinate care for pre-op optimization, for example for insulin adjustment or sleep apnea device titration? Options: Yes, multiple providers, Yes, one provider, No

Decision Triggers and Practical Next Steps

• If we could guarantee one practical thing right now, what would make you sign consent and schedule surgery today?
• Which timeline would be acceptable to you from clearance to surgery, for example 4, 8, or 12 weeks? Options: 4 weeks, 8 weeks, 12 weeks, More than 12 weeks, Unsure
• Who needs to be present at the pre-op planning meeting for you to feel confident about proceeding? Options: Surgeon, Nutritionist, Primary care provider, Family member or partner, Insurance representative, Psychologist, Other
• List the top three unanswered questions that would prevent you from giving informed consent today.
• Would you prefer a virtual pre-op program for counseling and labs, an in-person program, or a hybrid approach? Options: Virtual program acceptable, Prefer in-person only, Hybrid approach, Unsure

• Procedure Education & Expectations

• Confirm current state and its cost
• You confirm that the personalized procedure mapping addresses the hesitation that was causing dropouts and scheduling delays.
• Deliver a personalized procedure comparison sheet for this patient, including expected weight-loss ranges, complication rates, and a 12-month follow-up and supplementation plan.
• Review the patient's clinical profile
• You confirm the patient understands the expected weight-loss timeline and the key risks that would change the recommendation.
• Provide a one-page summary the patient can take home that lists daily diet stages, supplementation checklist, and common early warning signs that require contact.
• Map procedure options to this patient's context
• Confirm the patient's decision timeframe and supply the payer contact or authorization requirements needed to submit pre-authorization within that window.
• You confirm the documentation and timing required to proceed with insurance pre-authorization and scheduling.
• Collect any missing recent labs, imaging, or psychiatric clearance forms necessary to finalize perioperative risk assessment and scheduling.
• Demonstrate post-operative lifestyle and adherence needs
• Clarify insurance and authorization implications
• Validation checkpoint — confirm alignment

• Procedure Education & Expectations, Solution Experience
• Procedure Education Deck
• Procedure Education Solution Brief

• meeting
• slides
• document

• Laparoscopic Sleeve Gastrectomy
• Roux-en-Y Gastric Bypass
• Duodenal Switch Procedure
• Revisional Bariatric Surgery
• Outpatient Same-Day Surgery Pathway
• Inpatient Postoperative Care
• Preoperative Very-Low-Calorie Diet Program
• Insurance Pre-Authorization Submission
• Insurance Appeal and Clinical Documentation
• 12-Month Structured Postoperative Nutrition Program
• Vitamin and Mineral Supplement Starter Pack
• Telemedicine Postoperative Follow-Up
• Enhanced Recovery After Surgery (ERAS) Protocol
• Bariatric Behavioral Health Counseling

Laparoscopic Sleeve Gastrectomy

• Which sleeve variant are you planning (standard tubular sleeve, extended antral resection, or technical modification)? Options: Standard tubular sleeve, Extended antral resection, Custom modification — describe
• State the target bougie size you prefer for the sleeve (for example 34 French, 36 French). Options: 30 Fr, 32 Fr, 34 Fr, 36 Fr, 38 Fr, Other
• Identify planned adjunct intraoperative procedures that would change scope or operative time (hiatal hernia repair, cholecystectomy, adhesiolysis). Options: Hiatal/hernia repair, Cholecystectomy, Extensive adhesiolysis, None, Other
• Specify any patient anatomical or prior-surgery factors that affect approach (large fatty liver size, prior open abdominal operations, gastric band in situ).
• List the anticipated operative time range and any booking preferences for OR block length (example: 90-150 minutes; need extended block). Options: <90 minutes, 90-150 minutes, 150-240 minutes, Custom — describe
• Provide the planned early follow-up cadence after sleeve surgery (first clinic visit day, week 1, month 1, month 3) and any required imaging or labs at each visit.

Roux-en-Y Gastric Bypass

• Select the intended alimentary and biliopancreatic limb lengths in centimeters for the Roux-en-Y anatomy. Options: Alimentary 75 cm / BP 50 cm, Alimentary 100 cm / BP 50 cm, Custom lengths — describe
• Detail your preferred gastrojejunostomy technique (linear stapled, circular stapled, handsewn) and any drain/leak-test plan. Options: Linear stapled, Circular stapled, Handsewn, Require intraoperative leak test/OGD
• Name preoperative nutritional targets required before bypass clearance (albumin threshold, iron studies, vitamin D level). Options: Albumin ≥3.5 g/dL, Correctable iron deficiency required, Vitamin D ≥20 ng/mL, No fixed targets — describe
• Estimate whether intraoperative endoscopy or fluoroscopy will be used for intra-op assessment and how that affects OR resources. Options: Intra-op endoscopy required, Intra-op fluoroscopy required, Neither required, Unsure — discuss
• Specify anticipated post-op restrictions and monitoring unique to bypass that we should include in the scope (dumping syndrome education, routine iron/B12 checks).
• Identify any comorbidity-driven modifications to the bypass plan (severe GERD, chronic NSAID use, prior ulcer disease).

Duodenal Switch Procedure

• Which biliopancreatic limb and common channel targets are you considering (provide cm target for each)? Options: Common channel 75 cm, Common channel 100 cm, Custom lengths — describe
• Indicate whether you require staged DS (sleeve followed by bowel bypass) or one-stage primary DS. Options: One-stage primary DS, Staged DS — sleeve then bypass, Undecided — discuss
• Specify required pre-op nutritional optimization for DS patients (protein target g/kg, vitamin correction) as part of scope.
• List expected additional intraoperative resources for DS (longer OR block, specialized staplers, bariatric table), and check which apply. Options: Extended OR block, Specialized stapling devices, Bariatric operating table, Extra nursing/assist staff
• Provide your preferred post-op lab schedule for malabsorption monitoring after DS (frequency for albumin, iron, B12, fat-soluble vitamins).
• Identify patient selection constraints for DS in your program (age limits, renal disease exclusions, anticipated adherence concerns).

Revisional Bariatric Surgery

• Describe the previous bariatric operation(s) in the chart (banding, sleeve, bypass, other) and upload or summarize operative reports. Options: Adjustable gastric band, Sleeve gastrectomy, Roux-en-Y bypass, Other / multiple
• Identify the primary indication for revision in this case (weight regain, reflux, stricture, band erosion, malnutrition). Options: Weight regain, Reflux/GERD, Obstruction/stricture, Band erosion, Malnutrition, Other
• Specify additional diagnostics required before planning revision (contrast swallow, upper endoscopy, CT abdomen, nutritional panel). Options: Contrast swallow, Upper endoscopy (EGD), CT abdomen/pelvis, Comprehensive nutritional panel
• List surgeon or OR constraints that affect revisional scope (expertise with hostile abdomen, availability of advanced energy devices).
• Indicate if you require a documented risk/benefit addendum for revisional consent that we should include in the scoped deliverables. Options: Yes — include addendum, No — standard consent sufficient
• Provide any expected post-op escalation needs for revision cases (planned ICU bed, longer monitoring, stepdown unit). Options: Planned ICU, Stepdown unit, Standard ward, Extended observation

Outpatient Same-Day Surgery Pathway

• Define the specific clinical criteria you will require for same-day discharge (examples: pain controlled on oral meds, tolerating 500 mL liquids, ambulating independently).
• State the anesthesia and analgesia approach that supports same-day discharge (regional block, short-acting agents, multimodal analgesia). Options: General with short-acting agents, Regional block adjunct, Multimodal non-opioid plan, Other
• Identify home-support requirements that must be confirmed before same-day discharge (responsible adult overnight, proximity to ED, transportation). Options: Responsible adult overnight, Home within 1 hour of hospital, Access to 24-hour phone line, None required
• Specify remote-monitoring or post-discharge check mechanisms you want included (nurse call at 24 hours, tele-visit within 48 hours, wound photo submission). Options: 24-hour nurse call, Tele-visit within 48 hours, Photo-based wound check, Standard follow-up
• What objective criteria will define acceptance for same-day discharge in this patient (for example, pain ≤3 on oral meds, tolerating >500 mL fluids, stable vitals for 2 hours)?
• Provide any payer or facility restrictions that affect same-day pathway availability (payer denies same-day, facility lacks PACU capacity).

Inpatient Postoperative Care

• Indicate planned length of stay for the procedure in scope (same-day, overnight, 2-3 days, longer). Options: Same-day, Overnight (23 hr), 48-72 hours, >72 hours
• Specify the routine inpatient order set elements you require (VTE prophylaxis choice, opioid-sparing analgesia, PONV protocol, early mobilization schedule).
• List laboratory and imaging checks you want performed during inpatient stay (CBC post-op morning 1, basic metabolic panel, contrast swallow on day 1). Options: CBC day 1, BMP day 1, Contrast swallow, Other
• Identify escalation pathways for common complications you want codified in scope (fever algorithm, tachycardia with leak pathway, persistent vomiting).
• Specify nursing acuity or special certification needed on the ward (bariatric-trained nursing, bariatric equipment availability). Options: Bariatric-trained nursing, Bariatric equipment, Standard ward
• Provide discharge education topics that must be delivered before inpatient discharge (liquid diet progression, supplements, red-flag symptoms).

Preoperative Very-Low-Calorie Diet Program

• Provide the planned VLED duration for this patient (for example 2 weeks, 4 weeks, 8 weeks) and the target percentage pre-op weight loss. Options: 2 weeks, 4 weeks, 6 weeks, 8+ weeks, Custom — describe
• Indicate which VLED formula or regimen archetype will be used (meal replacement shakes, protein-sparing modified fast, clinic-supervised commercial program). Options: Meal replacement shakes, Protein-sparing modified fast, Clinic-supervised commercial VLED, Custom regimen
• List the documentation you will provide to show VLED participation (weekly weight log, dietitian visit notes, formula purchase receipts).
• Specify who will supervise the VLED in-scope (your clinic dietitian, external RD, PCP) and how many touchpoints are required prior to surgery. Options: Clinic dietitian, External registered dietitian, Primary care physician, Other
• Describe how VLED adverse events will be monitored and reported as part of the program scope (electrolyte checks, symptomatic reporting).
• What objective evidence will validate adherence to the VLED program for surgical clearance (for example weekly weight logs plus two dietitian notes)?

Insurance Pre-Authorization Submission

• Which payer(s) will the pre-authorization be submitted to and what are the known plan-specific criteria we must account for?
• Specify the CPT and ICD-10 codes you intend to use for the planned procedure and any ancillary services that require separate coding.
• List the clinical documentation pieces you will include with the PA submission (PCP referral letter, failed supervised weight-loss documentation, BMI documentation, comorbidity labs).
• Estimate the typical payer turnaround time and the target submission-to-decision SLA you need for scheduling. Options: <7 days, 7-14 days, 15-30 days, >30 days
• Identify who will prepare and sign the clinical narrative for the PA (surgeon, nurse navigator, medical director) and any supporting radiology or test reports required. Options: Surgeon, Nurse navigator, Medical director, Other
• What documentation will validate medical necessity for the PA in this case (for example, failed supervised weight-loss chart, HbA1c when diabetes present, documented comorbidity diagnostic tests)?

Insurance Appeal and Clinical Documentation

• Describe the common denial reasons you have encountered for similar cases (medical necessity, BMI documentation, missing prior treatment documentation).
• Specify the appeal timeframe and escalation steps we should plan for (internal appeal, peer-to-peer, external review). Options: Internal appeal, Peer-to-peer review, External independent review, All of the above
• List the clinical evidence types you want included in appeals (operative volume and outcomes summary, peer-reviewed literature citations, patient-specific longitudinal weight chart).
• Identify who will be the clinical lead preparing appeal narratives and whether a surgeon-signed letter is required. Options: Surgeon-signed letter, Clinical nurse specialist, Combined team
• Provide any payer-specific documents that require special formatting for appeals (signed forms, certified medical records).
• Indicate desired KPIs for appeal success tracking (time-to-decision, percent approvals on first appeal).

12-Month Structured Postoperative Nutrition Program

• Specify the follow-up frequency for dietitian visits during the 12-month program (examples: 1 week, 1 month, months 3, 6, 12). Options: Week 1, Month 1, Month 3, Month 6, Month 12, Monthly for 3 months then quarterly, Custom schedule
• List the postoperative lab monitoring schedule you require (iron studies, B12, folate, vitamin D, calcium) and the timing for each draw.
• Identify nutrition education materials or delivery formats to include (in-person counseling, printed guides, online modules). Options: In-person counseling, Printed guides, Online modules, Group classes
• Specify thresholds that will trigger intensified nutrition intervention (for example serum ferritin <50 ng/mL, hemoglobin drop >2 g/dL).
• Indicate whether meal progression milestones (clear liquids to pureed to solids) should be standardized in the scope and if so, provide the timeline you prefer. Options: Standardized timeline, Individualized per patient, Hybrid — standard with exceptions
• Provide expected documentation deliverables from the nutrition program (visit notes, supplement reconciliation, lab trend reports).

• Informed Surgical Consent
• Anesthesia Consent
• Financial Responsibility Agreement
• Insurance Pre-Authorization & Assignment
• Estimate of Charges and Payment Plan
• Authorization to Release Medical Information
• Surgical Scheduling Authorization & Mutual Obligations
• Advance Directive & Surrogate Decision-Maker Acknowledgment

• Post-op Go-live Health Check (weeks 1-4)
• First Outcome Review (4-10 weeks post-op)
• 90-Day Acceptance Gate Review
• Quarterly Long-Term Follow-Up Review

• Close resolved support tickets and escalate remaining issues according to the escalation pathway.
• Agree on specific corrective actions with clear deadlines for any nutrition, complication, or engagement gaps.
• Initiate an intensified nutrition follow-up or supplement adjustment plan with a documented timeline.
• Order repeat labs to monitor identified deficiencies within 14 days.
• Document the agreed corrective actions and the expected measurement date in the shared workspace.
• Restate acceptance criteria and numeric targets
• Produce a documented acceptance decision for each numeric target recorded in Clinical & Outcome Discovery.
• For any failed or conditional criteria, agree remediation actions, owners, and target dates and record them in the journey.
• Record the acceptance decision in the journey record within 48 hours.
• Create remediation tasks with deadlines for each unmet criterion and publish them to the shared workspace.
• Notify payer or authorization contact of the acceptance outcome where required for continued coverage.
• Review longitudinal weight trajectory and milestones
• Confirm whether patients are on track to meet the 12-month total weight loss target recorded in Clinical & Outcome Discovery.
• Reduce or close persistent nutritional deficiency issues and agree monitoring cadence for remaining issues.
• Ensure the shared support channel is resolving issues per the agreed escalation pathway.
• Update individualized maintenance plans for patients not on track, including dietitian and behavioral health touchpoints within 14 days.
• Schedule labs for the next monitoring window and flag abnormal results for early review.
• Reconfirm success criteria and owners
• All immediate recovery tasks are confirmed complete or scheduled within the first 7 days.
• Any clinical or administrative blockers are identified and have remediation actions and due dates.
• Obtain and record any outstanding post-op labs or imaging within 7 days.
• Confirm the patient's access to the shared support channel and the escalation pathway within 48 hours.
• Schedule the first outcome review for the 4 to 6 week window.
• Present first outcome data vs targets
• Determine whether percent total weight loss and 30-day complication incidence are moving toward the targets recorded in Clinical & Outcome Discovery.
• Validate immediate clinical status
• Assess nutrition labs and deficiency events
• Review nutritional labs and supplementation adherence
• Present 90-day outcomes vs each criterion
• Review late complications and readmissions
• Verify post-op orders and medication/supplement plan
• Document pass/fail per criterion and acceptance decision
• Root cause diagnosis for gaps
• Surface persistent issues and shared-channel tickets
• Agree corrective actions and timelines
• Agree remediation plan for failed or conditional criteria
• Early engagement signals
• Close administrative follow-ups
• Open issues and blockers
• Confirm readiness for the 90-day acceptance gate
• Agree next quarter maintenance plan
• Agree immediate remediation actions