Qualifying for Surgery

Bariatric surgery is indicated for individuals who weigh approximately 80 lbs or more over their ideal body weight and have failed to lose weight through conventional methods. To determine if your excess weight is sufficient to qualify you for surgery, your body mass index (BMI) is used. BMI is the ratio of your weight in kilograms, over your height in meters to the power of two (BMI=Kg/m2).

According to the 1991 National Institute of Health consensus conference criteria, bariatric surgery should be offered to individuals with BMI > 40, or individuals with BMI > 35 with obesity-related illnesses such as Diabetes, obstructive sleep apnea, high blood pressure, joint disease, etc. Surgery can also be offered to select individuals with BMI 30-35 if they have severe Diabetes not controlled with two or more medications. To determine your BMI, use the BMI calculator below.

 
BMI Calculator
Your Body Mass Index
 
What your BMI result indicates
  • Less than 19
    UNDERWEIGHT: You are under optimum weight for your height. You could afford to gain a little weight.
  • 20 - 25
    ACCEPTABLE: You have a healthy weight for your height.
  • 26 - 30
    OVERWEIGHT: You are over optimum weight for your height. You may be facing health problems, so losing some weight would be a good idea.
  • 31 +
    OBESE: You are over optimum weight for your height. You may be facing health risks, so see your doctor to help you achieve a healthier weight.

In addition to your BMI and medical conditions, Dr. Zaré will review other pertinent information in determining whether you are a suitable candidate for surgery. It is essential that patients choosing to have a life-saving bariatric procedure understand fully how the procedure works, what changes in lifestyle are required in order to maximize rewards after surgery, and what type of social support system will be beneficial to their long-term success. Our program will provide you education and support and help you reach you goal efficiently.

After a patient decides to proceed with surgery, there are two possible pathways to surgery. Patients can either use their insurance coverage to share in the cost of the surgery, or they may elect to finance the procedure themselves.

Insurance Pathway: 2-9 Months

Many insurance plans provide bariatric benefits and may be used to cover parts of the cost the procedure. The steps involved in using your health plan for coverage of bariatric surgery can be broken down to the following 5 steps.

qualifying

The first step is to confirm that your policy includes bariatric surgery benefits. You may do so by contacting your health plan and providing them the CPT code 43775 for Laparoscopic Vertical Sleeve Gastrectomy. Once benefits are confirmed, patients can enroll in our program and proceed with obtaining necessary evaluations and other insurance requirements. A complete list of requirements may be obtained from the health plan. These include assessments by registered dietitians, mental health specialists, medical specialists, etc. Also, they may include participation in a medically supervised weight-loss program lasting 3-6 months within a year of planned surgery. Once complete, a pre-authorization will be obtained, and surgery scheduled. It can take between 2-9 months to complete an insurance pre-authorization process. Our program will provide you support and oversight in determining the exact requirements and making sure those requirements are met prior to surgery.

Self-financed Pathway: 3 Weeks

Many individuals choose to self-finance their procedure and forego the process of insurance pre-authorization. These include individuals without insurance coverage, individuals with coverage but without bariatric benefits, or simply individuals interested in expedited care. For these individuals, the self-financed process typically takes 3 weeks to complete.

qualifying2

Financing is available. For additional information about this pathway, please click here.