Most insurance companies set their own requirements for patients to have the surgery covered. The most common requirements are based on National Institute of Health guidelines.
There is a weight requirement to qualify for surgery. However, since taller people are expected to have a higher healthy weight than shorter people, the “body mass index” is used to determine if you qualify for surgery. Insurance companies typically require a body mass index of 40 or more to qualify if you don’t have any weight related medical issues. A body mass index of 35 or more may qualify if you have at least one medical problem related to being overweight.
If you have a Body Mass Index (BMI) greater than 35, you may qualify for bariatric surgery.
Failed Prior Weight Loss Attempts
The vast majority of people considering weight loss surgery have already attempted numerous diet and exercise programs prior to visiting the surgeon’s office or seminar. However, most insurance companies require “proof” of an organized program before they will approve payment for the surgery. A typical requirement would be for a 3 or 6 month physician supervised diet with at least monthly documentation in the medical chart recording the date, current weight, and any interventions that are being performed for the diet.
There is always a requirement that patients pass a psychological screening prior to scheduling surgery. The purpose of the screening is to ensure that patients will have an understanding of the procedure and as well as understand the life changes that will occur after surgery. Additionally, some patients have emotional instability, depression, anxiety, or other issues that will need to be addressed prior to surgery.
Commitment to Lifestyle Change and Medical Follow Up
No mainstream surgery being performed today will guarantee durable weight loss results without life style modification. This includes keeping a food diary, making healthy food choices, limiting portion sizes, and starting an exercise program. Additionally, it is essential to follow up regularly with your surgeon to check your vitamin levels and screen for symptoms, such as vomiting or abdominal pain, that might indicate a complication from the surgery has occurred. Weight regain after surgery can be minimized if it is recognized early and interventions are undertaken to reverse it.
As with any surgery, you must be medically fit enough to undergo general anesthesia. Your surgeon may ask your primary physician or cardiologist to provide a letter indicating that you are healthy enough to undergo the surgery.