Getting Started
Thinking about bariatric surgery? This page covers everything you need to know to get started—from understanding if you qualify and how BMI plays a role, to preparing for surgery and exploring payment options. Whether you’re just beginning to explore your options or ready to take the next step, this guide will help keep you informed on what’s next.
Do I Qualify for Bariatric Surgery?
The National Institutes of Health (NIH) released the first formal criteria for bariatric surgery in 1991. These initial guidelines recommended bariatric surgery for patients with:
- A body mass index (BMI) of 40 or greater.
- A BMI of 35 or higher with significant comorbidities (obesity-related health conditions) such as type 2 diabetes, heart disease, sleep apnea, high blood pressure, high cholesterol and triglycerides, debilitating joint pain, and more.
That’s right—you read it correctly. These criteria, which have largely remained unchanged and are still used by insurance companies, date back almost 35 years. Of course, they are now considered outdated. They were crafted before laparoscopy became common. Back then, open procedures were risky and rightly required stringent criteria.
Today, bariatric surgery is performed using minimally invasive techniques, reducing risks to less than 1% while achieving excellent results. However, for financial reasons, insurance companies still make coverage difficult—saving money for themselves while causing unnecessary delays and suffering for patients. This is also why insurance companies often require 3–6 months of nutritional consultation. Patients who have already tried countless diets and remain obese now have to wait even longer—often 3–6 additional months—for no reason other than cost.
We know that diets and exercise alone rarely lead to meaningful, sustainable weight loss. That said, diet and exercise are essential for maintaining weight loss and overall health.
In my practice, anyone with a BMI of 28 or higher, with or without comorbidities, may qualify for surgery depending on their individual circumstances, including their reasons for seeking surgery and previous weight-loss attempts, especially if they are now regaining weight they had previously lost.
Bariatric Surgery Expectations
Qualifying for bariatric surgery depends on several factors, including your BMI, overall health, and insurance or payment method. Most insurance plans require a BMI of 40 or higher, or a BMI of 35 or higher with obesity-related conditions, along with other criteria such as psychological evaluations or supervised diets. Your medical history and surgical risk will also be carefully evaluated to ensure the procedure is safe and appropriate for you.
Paying for Bariatric Surgery
There are several options for paying for bariatric surgery, including insurance coverage, financing, and paying with cash. Insurance may cover a large portion of the cost, but it often comes with strict qualification requirements. Financing offers more flexibility but may involve interest and credit checks. Paying out of pocket provides the most freedom and may result in reduced costs through bundled pricing. It’s essential to carefully explore each option and consult with your bariatric office to determine the best fit for your specific situation.
Insurance Coverage
Insurance coverage for gastric sleeve surgery varies by provider and plan. Some companies offer clear bariatric benefits, while others do not cover the procedure at all. If you’re unsure, we recommend contacting your insurance provider directly to confirm your eligibility and benefits. We can also help you verify your benefits, so please feel free to call us with your insurance card in hand.
Preparing for Bariatric Surgery
Preparing for bariatric surgery is as important as the procedure itself. Patients must undergo medical evaluations to ensure that the surgery is safe and appropriate, taking into account their overall health. Mental readiness is also crucial, as success depends on a long-term commitment to lifestyle changes, such as diet, exercise, and quitting smoking. Even small weight loss before surgery can reduce risk and improve outcomes. The preparation process plays a crucial role in long-term success and safety.
What Is The BMI?
BMI (Body Mass Index) is a helpful starting point for determining if someone may qualify for bariatric surgery, but it’s not a perfect measure. It doesn’t account for factors like gender, muscle mass, body frame, or age. While BMI provides a general guide, a comprehensive evaluation by our team is necessary to determine if bariatric surgery is the right option for you.
