Bariatric Surgery Requirements: What Can Disqualify You?

If you struggle with your weight or have ever tried to lose weight just to become frustrated with your lack of progress you may need some help. For Individuals who have a BMI of over 35, losing weight on your own can be an impossible task because your metabolism, genetics, hormones, or even medications can be working against you.

Bariatric surgery may be the right solution to help you successfully lose weight and become healthier. If you are considering undergoing bariatric surgery it is important to know that an individual cannot just decide to have bariatric surgery and then have it happen in a week or two.

There is a process that must be followed and a patient must have met certain criteria for bariatric surgery before it can take place. Today we are going to shed some light on the bariatric surgery requirements and also what can disqualify you from bariatric surgery.

Qualifying For Bariatric Surgery

If you are relying on your medical insurance to pay for your weight loss surgery or part of your surgery, the qualifications for bariatric surgery may be different than if you are bearing the cost on your own. There are standard bariatric surgery qualifications that are universal and then there are those specific to the insurance carrier.

Universal Bariatric Surgery Requirements

The standard qualifications for bariatric surgery include:

  1. The patient must have a body mass index in the range of 40 or above or be at least 100 pounds overweight or
  2. The patient must have a body mass index in the range of 35 or above and suffer from at least one comorbidity such as hypertension or type 2 diabetes, etc.
  3. The patient must have diligently tried to lose weight through other channels but been unsuccessful.

Insurance And Bariatric Surgery Requirements

You must meet certain qualifications for bariatric surgery especially if you are relying on insurance to pay a portion or for all of the procedure. First, you must meet all the standard requirements listed above but next, you must meet any additional qualifications set forth by the insurance company. A typical list of bariatric surgery requirements from an insurance company may include:

  • The patient must be at least 18.
  • The patient must meet all the universal criteria for bariatric surgery.
  • Patients must have documented proof that they have tried to lose weight through a structured program that was at least 6 months long or two programs that were 3 months long each and done independently. This documented attempt at weight loss must have taken place within the last two years. An example of a structured weight loss plan would be Jenny Craig or Weight Watchers.
  • Patients must submit to a psychological exam to ensure they are willing to make the lifestyle changes needed (including the lifetime commitment to maintaining a healthy low-calorie diet and an exercise program) to achieve weight loss and maintain it long term.

What Can Disqualify You From Bariatric Surgery?

Even if a patient meets the basic universal criteria for bariatric surgery, it is possible they could be disqualified by their insurance company or the surgeon. Issues such as eating disorders, a history of blood clots, heart problems, or certain health conditions can disqualify a patient as a candidate for bariatric surgery.

If a patient is approved initially for the procedure there is a chance the surgery could be delayed or canceled by the bariatric surgeon under certain circumstances. Patients are given pre-surgery guidelines and a diet they must follow before surgery can take place. If the patient can not follow the guidelines or adhere to the diet the surgery could be delayed or canceled. This may suggest the patient is not able to handle the responsibility that they will be met with post-surgery.

What Happens If I Don’t Meet The Criteria For Bariatric Surgery?

Patients who do not qualify for bariatric surgery for medical reasons or other reasons may do well with a non-surgical weight-loss procedure such as the Orbera gastric balloon or Suture Sculpt endoscopic sleeve gastroplasty (ESG).

Most people are eligible for either of these procedures and neither requires any incisions or a hospital stay and both offer a short recovery time. Both ESG and Orbera offer substantial potential for weight loss and many patients have reported amazing results.

If you are trying to lose weight, we are here to help! Batash Endoscopic Weight Loss Center’s team of professionals is ready to support your weight loss efforts and help you reach your weight loss goals. Contact us today to learn more about surgery-free Suture Sculpt ESG and Orbera Balloon. Today can be the first day of your weight loss journey and healthier life!

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