By: Michael J. Orris, D.O., M.B.A., FASMBS

Many weight loss patients in Phoenix, Tempe, Scottsdale and Tucson come to our bariatric surgery practice seeking to improve their health through surgery. Like bariatric surgery patients across the U.S., many are concerned about the cost. Insurance coverage for these procedures varies by state and provider, and many other factors are also considered.

Most insurance providers, including Medicare, require patients to have thorough documentation from a doctor that says surgery is medically necessary. This includes your weight history and BMI, your obesity-related health conditions and medications, and a detailed description of how your weight affects your daily life.

Companies also often expect a patient to have made dedicated efforts at weight loss before surgery. They may want to see gym membership documentation or require participation in a medically supervised weight loss program for up to 6 months.

Another consideration for coverage is where a patient can have the surgery performed. Some providers require patients to have their procedures done at facilities with the highest standards and success rates.

Your weight loss doctor can be a resource to help you get your surgery covered. Most practices have finance coordinators who can help you navigate the complicated insurance considerations. If you do not qualify, many practices also offer other financing options such as payment plans to help you get your health back on track.

Concerning Weight Loss Surgery Candidacy

Patients often want to know what qualifies a person for bariatric surgery. All patients must undergo a thorough screening from a physician to know whether surgery might work for them, but here are some factors that might make you a candidate:

· What is your BMI?

Obesity is measured by calculating a patient’s body mass index, or BMI. Bariatric surgery patients typically have a BMI above 40, or above 30 if they also have a medical condition related to obesity, such as diabetes. You can determine your BMI by using a BMI calculator.

· Have you tried and failed with other weight loss options?

Most insurance providers and reputable weight loss surgeons require that you have made a concerted effort to lose weight using more traditional methods before you undergo surgery. You should be eating a good diet and exercising regularly under the guidance of a bariatric specialist. If your doctor determines that such methods are not enough to improve your health, you may be a candidate for surgery.

· Is your health at risk?

If life-threatening medical conditions related to obesity are a factor, you may qualify for surgery. Diabetes, heart disease, high blood pressure, and sleep apnea often result from obesity and can be relieved by bariatric surgery. If you have one of these medical concerns and think you may be a candidate for surgery, talk to a bariatric specialist.