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Am I a Candidate for Surgery?

Weight loss surgery is major surgery, and it is not appropriate for everyone who wants to lose weight. Candidates for weight loss surgery include:

• People with a body mass index (BMI)* of 40 or greater.
• People with a BMI of 35-40 who also have health problems associated with obesity. These problems can include diabetes, sleep apnea, hypertension, heart disease, and degenerative joint disease.

Before being considered for this operation, you must be evaluated by an experienced surgeon and be considered an appropriate candidate. You also must have tried other weight loss programs, and be motivated and committed to the overall bariatric surgery program, which includes certain lifestyle changes.

Most insurance plans will pay for weight loss surgery and follow-up care as long as the National Institutes of Health guidelines for body mass index are used as qualifying criteria. However, some plans do have a weight loss surgery exclusion clause and some plans may require a period of monitored dieting prior to approval. Should you want to check your coverage, a list of commonly used insurance companies and their links are listed below.

Approval must be obtained for your preoperative visit with your surgeon, as well as the surgery itself. The approval process for surgery may take as little as a few weeks, but most likely will take a few months once the process has started. The bariatric nurse specialist at Columbia St. Mary’s will assist you with obtaining authorization. Your surgeon will also send a letter to your insurance company to document why the procedure is medically necessary. In some cases appealing an initial insurance denial or even changing insurance companies may become necessary.

* Body Mass Index is calculated as the weight (in kilograms) divided by the square of the height (in meters). It correlates with the amount of fat in the body.