Do I Qualify for Bariatric Surgery?

Bariatric surgery qualification standards will vary between surgeons, insurance companies, and states, and it is almost impossible to know whether you will qualify for surgery before starting the process. Factors such as age, surgical risk, gender, form of payment, surgeon, and insurance company will all play a part in whether you qualify for any of the main bariatric surgery procedures.

Below you will find a general guide to qualification standards, some or all of which may apply to you:

  • Age: Age is a significant factor in qualifying for weight-loss surgery. Most surgeons and practices will perform the procedure on patients between 18 and 65 years old. Patients under the age of 18 may not be fully physically developed and surgery may have adverse effects on their continued growth. Conversely, patients over the age of 65 may not have a suitable surgical risk profile as their age may make it more difficult for them to recover from a major surgical procedure. There are surgeons that do specialize in adolescent weight loss surgery as well as surgery for older patients, however no matter the surgeon, each case will be evaluated on an individual basis.
  • Excess Weight: Generally speaking, a person may qualify for surgery if they are approximately 100 pounds or more over their ideal weight. Figuring out ideal weight and qualification for surgery has been made easier by the Body Mass Index or BMI. BMI is a measure of obesity by analyzing weight and height. By using a BMI calculator, a prospective patient can estimate their suitability for surgery. Patients with a BMI of 30 or over, with one or more obesity-related disease, may qualify for Lap-Band® surgery. Patients with a BMI of 35 or over, with one or more obesity-related disease, may qualify for all other bariatric surgery procedures including gastric bypass, gastric sleeve, Realize® Band and more. Patients with a BMI of 40 or over may qualify for any bariatric procedure with or without the presence of obesity-related diseases.
  • Surgical Risk: General health, previous procedures performed on the patient, as well as any diseases, chronic or otherwise, may play a part in determining whether or not the patient has an acceptable level of surgical risk. Very few bariatric surgeons will perform a procedure on a patient with high surgical risk, because at a certain point, the risks of surgery will outweigh the risks of living with obesity. Patients with significant scar tissue in the abdominal area, as well as those who may have trouble recovering from surgery because of a compromised immune system, will likely be considered higher risk. Testing before surgery, including cardiological exams, pulmonary exams, kidney and liver function tests and blood tests will help the practice determine whether or not a patient qualifies for surgery.
  • Psychological Factors: Patients will experience a drastic change in their lives and lifestyles after surgery, making it important for the practice to know that the patient is psychologically prepared to handle them. Almost invariably, patients will undergo a routine psychological evaluation as part of their pre-op program to gauge if they are good candidates for surgery.
  • Form of Payment: If you intend to pay for your surgery by cash or through third-party financing, restrictions are relatively low. However, if you intend to use insurance, you may find that the insurance company has its own set of qualification criteria. Insurance companies do not necessarily cover every procedure although the three main procedures — gastric bypass, gastric sleeve and gastric banding, are covered by most major bariatric surgery insurance policies. You may find that your insurance policy does not cover bariatric surgery at all, so as a first step, it is important to call them or speak to the human resources department at your place of employment to review your benefits. Medicare and Medicaid also have their own set of qualification criteria. Click here for more information on Medicare and Medicaid for bariatric surgery.

While this is by no means an exhaustive list of qualification criteria, learning more about each of the points above should help you determine whether or not you qualify for surgery. Most bariatric surgery practices will offer free insurance verification and will help you evaluate your particular circumstance. Further, after an initial consultation with the surgeon, you will get a very good idea of your eligibility for surgery. The first step, however, is to attend one of their free bariatric surgery seminars, which will help you choose a surgeon and decide which program is best for you.

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