Getting Started & Qualifying for Surgery

Not all individuals meet the criteria for bariatric surgery. Our bariatric team has compiled the following information to help clarify our program requirements. Please do remember that every individual has different health circumstances. Therefore, we work with each of our patients on an individual basis to determine the best treatment options for them within our program.

Step 1: Check Body Mass Index

Body Mass Index or BMI is a standardized measure used to describe the physical size of an individual. BMI is essentially a number that is calculated by measuring a patient’s height and weight. Patients who have a BMI ≥ 30 are generally considered to be obese. However, not all obese patients qualify for every bariatric procedure. Some patients with a BMI ≥ 30 and who have one or more obesity-related diseases may qualify for an adjustable gastric band. Individuals with a BMI 30 to 40 are candidates for an intragastric balloon procedure. Roux-en-Y gastric bypass, sleeve gastrectomy and duodenal switch patients must have a BMI ≥ 35 with at least two obesity-related diseases. Individuals with a BMI ≥ 40 automatically meet the BMI requirement for most bariatric surgery procedures. Remember, BMI is not the only qualifying factor for bariatric surgery, however, its serves as a starting point for discussing treatment options.

Step 2: Understand Payment Options

Weight loss surgery is expensive. Patients should understand their payment options early on in the process. Our bariatric coordinator will help verify insurance benefits, and estimate out-of-pocket expenses. We do, however, suggest that patients contact their insurance company directly to understand policy benefits and to speak with a qualified insurance professional. Insurance coverage will vary between companies and between individual plans, so it is important to ensure that bariatric surgery is covered, in addition to any other coverage benefits. Individuals who do not have appropriate insurance coverage may consider financing and/or cash pay options. Again, please contact our office for more information on financial arrangements.

Step 3: Understand Insurance Requirements for Bariatric Surgery

If bariatric surgery is covered through an insurance plan, the insurance company will have its own pre-surgery qualifying criteria. These requirements will vary between insurance companies. Some insurance plans may require documentation of no smoking or tobacco products and up to six months of medical weight loss. Other medical documentation may be requested as well. Following through with all of the insurance requirements will allow our bariatric coordinator to submit documentation to the insurance company for surgery preauthorization. Medicare and Medicaid patients will also need to follow strict qualification criteria to be considered a bariatric surgery candidate. Our bariatric coordinator will be happy to answer questions regarding private insurance, Medicare or Medicaid requirements.

Step 4: Attend a Seminar

Our bariatric team provides in-person seminars on a weekly basis. Our goal is to explain the role of each medical provider on our bariatric team, and what we do to coordinate medical care for the patient. Our program is built around the individual, his/her needs, and what we can do to improve the communication and continuity of medical care. We want the patient’s medical experience to be emotionally positive, with the benefit of a healthier weight and lifestyle. The in-person seminars help individuals understand that bariatric surgery is a ‘tool,’ which can enhance weight loss. Changing eating and exercise behaviors, however, is required by the patient in order to lose a significant amount of body weight and to maintain that weight loss long term. Our bariatric seminars provide a broad scope of treatment options, including non-surgical weight loss and the different types of bariatric surgery procedures. We want to inform individuals about our program options, however, ultimately, the patient needs to decide if they want to join our team for treatment.

Step 5: Schedule Bariatric Screening

We provide bariatric screening appointments in conjunction with our bariatric seminars. This allows for patient convenience, and it gives the patient a chance to ask our bariatric providers personal questions they may have from the seminar information. Our bariatric coordinator schedules these appointments when interested individuals inquire about our bariatric program. During the screening process, we are interested in the patient’s medical and family history, prior weight loss attempts, eating patterns and a variety of other factors that may be affecting the individual’s body weight. Overall, we are interested in the patient’s current emotional and physical health status, and what we can do as a bariatric team to improve one’s health condition through obesity treatment.

Step 6: Schedule Pre-op Testing

If a patient qualifies for bariatric surgery, then pre-surgery testing is the next important step. Our bariatric coordinator provides each patient with a checklist of things that must be completed before a surgery date is scheduled. Some insurance companies require heart, lung and kidney function tests as well as simple blood and urine testing. Medicare, Medicaid and some insurance companies also require weight loss before surgery. A psychological evaluation is sometimes required to make sure an individual is emotionally ready for a significant life style change. The pre-surgery timeframe may extend anywhere from two to six months before a surgery date is scheduled. Therefore, we encourage patients to follow through with all of their clinic appointments, insurance requirements and to engage in the pre-surgery process, so there are no delays in the treatment schedule.