Do I Qualify for Bariatric Surgery?

Finding out that there are strict criteria governing the eligibility for bariatric surgery can be a surprise. However, our practice firmly believes that bariatric surgery, while suitable for most morbidly obese patients, does have risks and considerations that make it necessary to perform comprehensive pre-operative screening and testing.

Our practice adheres to the guidelines set forth by the FDA for patients to qualify for bariatric surgery. These are the minimum criteria for eligibility:

  • Having a BMI of 30-34.9 with one or more diseases associated with morbid obesity for patients looking to undergo the Lap-Band procedure (bear in mind this may not be covered by insurance)
  • Having a BMI of 35 or over with one or more diseases associated with obesity (e.g. high blood pressure, diabetes or high cholesterol)
  • Having a BMI of 40 or over regardless of the diseases associated with morbid obesity
  • 3-5 year documentation of BMI at the above ranges
  • Five year history of failed diets

Insurance Considerations

It is important to remember, however, if you are paying for bariatric surgery using your insurance plan, they may have specific requirements above and beyond our own. You will have to meet these criteria before being approved for the procedure. Requirements vary between insurance companies and even between plans offered by the same insurer. As a result, we suggest you call your insurance company and find out exactly what your benefits are. In most cases, we can help you perform an insurance verification. Some of the most common insurance-related qualification criteria include:

  1. Up to 6 months or more participation in a medical weight loss
  2. Documentation of failed diet and exercise programs
  3. Quitting smoking (up to 8 weeks prior to surgery)
  4. Letter from a primary care physician
  5. And possibly more

Medicare and Medicaid have their own set of criteria which must be adhered to for coverage.

Pre-Op Testing

Before surgery, you will undergo a series of diagnostic tests that will help us determine if the benefits of having surgery outweigh the risks. These clearances can be obtained from your primary care physician or specialist, or you can speak to our office about arranging for referrals to our affiliated specialists. Tests may range from pulmonary and cardiac testing to blood work and a psychological evaluation. Learn more about pre-op testing.

Ultimately, the decision to have surgery must be based in patient safety and that is our primary goal. If you have any questions about qualifying for surgery, or steps you can take to ensure coverage for your procedure, we encourage you to contact our office

What's My BMI

Calculate