Bariatric surgery, or weight loss surgery, can help morbidly obese individuals improve their health and quality of life through significant weight loss. However, only 1 percent of the approximately 15 million Americans with morbid obesity--a body mass index of 40 or more--are being treated with bariatric surgery, reports the American Society for Bariatric & Metabolic Surgery. Patients interested in weight loss surgery must meet the surgeon's qualifying criteria as well as those of his health insurance carrier.
Step 1
Ask your primary care provider if you might be a candidate for bariatric surgery. The threshold qualification is a body mass index of at least 40 in an individual who has no obesity-related conditions or co-morbidities, according to the National Institutes of Health. The BMI is a figure calculated from your height and weight that approximates body fat percentage and is an indicator of obesity. A person who has co-morbidities, including type 2 diabetes, sleep apnea or high blood pressure, may qualify for bariatric surgery with a BMI between 35 and 39.9.
Step 2
Gather information from your health insurance carrier about coverage for bariatric surgery. Ask about the insurer's criteria; which procedures are covered, if any; what documentation is needed; and which expenses you must pay out of pocket. Find out which bariatric surgeons are on their provider list and ask about the referral process. Each time you speak to a representative, make a note of the date, time, name of the representative and what was said.
Step 3
Ask your primary health care provider for a referral to a bariatric surgeon. Convey the information you received from your insurer about the qualification process and provide any documentation that must be included with the referral.
Step 4
Gather documentation of your previous weight loss efforts and weight-related illnesses. Some surgeons and insurers require the patient to provide copies of medical records while others ask you to complete a detailed questionnaire.
Step 5
Listen carefully to the bariatric surgeon about her requirements. Surgeons' guidelines vary, but in general they want to see that you can physically withstand the procedure, are psychologically and emotionally capable of making long-term lifestyle changes and are motivated to lose weight.
Step 6
Follow the instructions of your surgeon and health care insurer to ensure that you meet all necessary requirements. You may need to be cleared for surgery by a cardiologist or other specialist; undergo special testing for sleep apnea or digestive disorders; quit smoking; lose weight; undergo psychological evaluation; and attend nutrition classes.
Step 7
Attend a bariatric surgery support group meeting or join an online bariatric surgery forum. These groups provide helpful information about the various stages of weight loss surgery and recovery, including tips on qualifying for surgery.
Step 8
Follow up with your surgeon's office and health care insurer at least every two weeks to determine if they need further information or action from you. If the surgeon determines that you are not a good candidate for surgery at this time, find out what you need to do to qualify in the future. If the surgeon approves you but your health care insurer refuses to cover the procedure, follow the appeal procedure if appropriate.
Tips and Warnings
- The most common bariatric procedures performed in the United States are the gastric bypass, adjustable gastric band, gastric sleeve and bilio-pancreatic diversion with duodenal switch. Your surgeon will discuss the options with you and recommend the procedure that she feels will best suit your needs Approximately 25 percent of patients requesting weight loss surgery are denied by their health care insurers three times before being approved, according to the American Society for Bariatric & Metabolic Surgery.
- Risks of bariatric surgery increase in patients over the age of 65, according to MayoClinic.com. Use of bariatric surgery in adolescents under the age of 18 is controversial. Bariatric surgery is not a quick fix for weight loss; it requires changing your lifestyle on a long-term basis, including modifications to eating and physical exercise patterns.
Things You'll Need
- Books and articles about bariatric surgery
- Health insurance coverage manual or website
- Medical records
References
- MayoClinic.com: Gastric Bypass Surgery: Who Is It For?
- National Association for Weight Loss Surgery: How to Regain-Proof Your Weight Loss Surgery
- National Institutes of Health: Weight Loss Surgery
- American Society for Bariatric & Metabolic Surgery: Obesity in America
- American Society for Metabolic and Bariatric Surgery: Metabolic and Bariatric Surgery
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