We shared A Bariatric Story earlier and this one is about a question we get asked a lot….
Do I qualify for Bariatric Surgery❓❓❓
First you need to know if your BMI qualifies and then from there we can tackle the conversation of insurance and coverage. Working with our nursing staff hand-in-hand will ensure you a seamless process!
Learn More About the Orbera Stomach Balloon Procedure
Qualifications for bariatric surgery in most areas include:
BMI ≥ 40, or more than 100 pounds overweight.
BMI ≥ 35 and at least one or more obesity-related co-morbidities such as type II diabetes (T2DM), hypertension, sleep apnea and other respiratory disorders, non-alcoholic fatty liver disease, osteoarthritis, lipid abnormalities, gastrointestinal disorders, or heart disease.
Inability to achieve a healthy weight loss sustained for a period of time with prior weight loss efforts.
For example, an adult who is 5’11″ tall and weighs 290 lbs would have a BMI over 40. Calculate your BMI.
The NIH, as well as the American College of Surgeons (ACS) and the American Society for Metabolic and Bariatric Surgery (ASMBS) also recommend that surgery be performed by a board certified surgeon with specialized experience/training in bariatric and metabolic surgery, and at a center that has a multidisciplinary team of experts for follow-up care. This may include a nutritionist, an exercise physiologist or specialist, and a mental health professional. In addition, some insurance companies require that the surgery be performed at a facility that meets the ASMBS-approved quality standards (MBSAQIP). Facilities which meet high standards or quality, like those outlined in MBSAQIP, are preferable choices for patients.
Start on our site and calculate your BMI, then click to the Contact page and a message a nurse. From there someone will follow up and get the process started… we’re here to make things easy and exciting for you!
Why Would I Be Denied by Bariatric Surgery?
Bariatric surgery is a weight loss procedure, and as such, it is typically only recommended for those who are significantly overweight or obese. In order to qualify for the surgery, patients must have a body mass index (BMI) of 35 or higher and have obesity-related conditions or a BMI of 40 or higher with no related conditions. If a person does not meet these criteria, they will likely be denied bariatric surgery. Furthermore, if a person has other underlying health conditions, such as a history of substance abuse or severe mental health conditions, then they may also be denied for surgery. Additionally, if a person does not demonstrate a commitment to lifestyle changes, such as proper exercise and healthy eating habits, then they may be denied bariatric surgery.
In conclusion, to qualify for bariatric surgery, an individual must typically have a BMI of at least 40 or more than 100 pounds overweight or a BMI of at least 35 with one or more obesity-related co-morbidities. Additionally, it is recommended that the surgery be performed by a board-certified surgeon with specialized experience/training in bariatric and metabolic surgery, and at an MBSAQIP-approved facility.
