Qualifying for Bariatric Surgery

Knowing whether you qualify for bariatric surgery is likely one of the first questions on your mind. The qualification process for weight loss surgery is a relatively long one when compared to other surgical procedures because there are so many factors that have to be taken into account before we can approve the average patient for surgery.

• First, there needs to be a reason behind surgery. This is called medical necessity and most insurance companies including Medicare and Medicaid require this to cover the surgery. Typically, the Body Mass Index or BMI along with one or more obesity-related, medical conditions are needed to prove medical necessity. The insurance company wants to ensure that the patient is doing this for their health rather than just for aesthetics. In fact, when considering bariatric surgery, improving your health should be number one reason you choose to undergo this procedure. Weight loss is simply a great side effect.
• Age, Body Mass Index and diseases associated with obesity are all integral parts of qualifying for bariatric surgery. We perform surgery on patients 18 to 65 which we consider to be the age range most likely to benefit from bariatric surgery. However some exceptions, younger or older, may apply. The Body Mass Index or BMI is a measure of obesity and one of the first criteria used to evaluate eligibility. Body Mass Index of 35 or over generally qualifies the patient for surgery if they have one or more diseases associated with obesity including type II diabetes, high cholesterol, high blood pressure, sleep apnea and more. These diseases are known as comorbidities. A BMI of 40 or more generally qualifies for bariatric surgery regardless of comorbidities.
• The patient’s general health will also be a deciding factor in whether they are suitable for surgery. Of course, the risks of surgery should be lower than the risks of living with obesity, and the patient’s general health including their heart, lungs, liver and kidney functions will help us determine if they’re suitable for the surgery. The benefits of surgery should always outweigh the risks; pre-operative testing goes a long way to ensuring they do.
• Finally, the method of payment will may also determine whether a patient qualifies. Many insurance companies cover bariatric surgery, but will have their own set of criteria the patient needs to meet to ensure coverage. Patients who pay by cash or finance their procedure through a third party have more flexibility.

Weight loss surgery is an option to explore if you’re suffering from obesity and its related diseases. Rest assured that our team will perform a thorough analysis to ensure your eligibility for surgery including an insurance verification. You will then work with one of our surgeons to evaluate whether a gastric sleeve or gastric bypass is right for you, gaining the knowledge and understanding of what to expect before and after the procedure. We will then work with you to get the appropriate clearances and pre-approval from your insurance company. But the hardest step is often recognizing that you may need surgery, so you’ve made a huge step already. We look forward to meeting with you and discussing your needs and suitability for surgery.