Getting Started / Qualifying for Weight Loss Surgery

The decision to undergo bariatric or weight loss surgery is not easy; however, if you have reached this page, we want to congratulate you on taking the first step toward a new life!

To qualify for bariatric surgery you will want to ensure that it is right for you and that you qualify for insurance coverage. We have compiled the guide below to give you an idea of whether you may be a candidate for bariatric surgery. Please do remember that every patient’s health circumstances are different. Only a consultation with one of our surgeons can determine whether you will genuinely benefit from bariatric surgery.

Step 1: Check Your BMI

Guidelines set by the FDA, and adhered to by our practice, revolve around a primary measure of obesity called the body mass index or BMI. Patients who have a BMI of over 30 are generally considered obese. However, not all obese patients qualify for all bariatric procedures. Typically, patients must have a BMI of 35 or over to qualify. Gastric bypass, gastric sleeve, and duodenal switch patients must have a BMI of 35 or above with one or more obesity-related diseases or a BMI of 40 or over, regardless of their health. Remember, however, that the BMI is not the be-all and end-all, and variations in the BMI can occur due to age, muscle mass, and gender.

Step 2: Understand your payment options

Weight loss surgery is not inexpensive, and as such, the patient should understand their payment options early on in the process. We will be more than happy to assist you with verifying your insurance benefits to give you an idea of your out-of-pocket expenses versus those covered by insurance. However, we suggest that you contact your insurance company directly to understand policy benefits. Insurance benefits and requirements vary between companies and plans, so it is essential to ask questions. Those who do not have appropriate insurance coverage may consider financing or cash-pay options to finance their surgical procedure. We will be more than happy to assist you with understanding all the options available to you.

Step 3: Understand Insurance requirements.

If it covers bariatric surgery, your insurance company will have a set of criteria to ensure that weight loss surgery is right for you and that you have exhausted all other reasonable options. These requirements will vary between insurance companies and may include a course of medical weight loss between three and six months, letters from your primary care physician stating you will benefit from surgery, and other criteria. Compiling these documents accurately will allow you to receive a preauthorization for surgery more quickly. Medicare patients should understand that there is no preauthorization process for their strict qualification criteria. We suggest that you work closely with your primary care physician and us to fully understand your private insurance or Medicare criteria to help ensure coverage.

Step 3: Attend a Seminar

If you have begun researching weight loss surgery, you will likely have seen mention of the weight loss surgery seminar. These seminars may seem trivial; however, they are significant first steps to allow you to understand how bariatric surgery can change your life and if it is the right option for you. Seminars are also a way for you to learn more about our practice and understand the responsibilities associated with the journey you are about to embark on. As such, we require that all of our patients attend. Upon completing the seminar, we will contact you to schedule a consultation with one of our surgeons.

Step 4: Schedule a Consultation

Your first consultation will be an exciting time, during which you will meet various members of our team, including the surgeon who will perform your upcoming procedure. The consultation allows us to answer your questions one-on-one and learn more about your specific health situation to determine whether weight loss surgery will benefit you. We will also help you choose a procedure. We hope that you take the time with us to learn more about our practice and ask questions that will make you feel at ease about your decision. After all, the weight loss surgery process is a lifelong one, and we expect to be by your side the entire way.

Step 5: Get your Pre-op Testing

Preoperative testing seems like a nuisance; however, it is crucially important to ensure that you do not have any hidden medical issues that may hinder your ability to benefit from bariatric surgery or create complications during or after the procedures are complete. We will conduct a series of tests based on your insurance company’s requirements and the results of our initial consultation. These may include heart, lung, and kidney function tests and simple blood and urine tests. If you have received recent testing from your primary care physician or any specialist, we may be able to use those findings. You will also undergo a nutritional and psychological evaluation to prepare you for life after surgery.

Once you have been cleared for surgery, Congratulations! However, while the paperwork is over, your journey is just beginning. You will now be scheduled for surgery. This is the time to discuss your decision and what to expect after surgery with those around you and get ready for a renewed dedication and focus on your health.