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What Requirements are Needed for Weight Loss Surgery?

Aug 02, 2022

There are many types of weight loss surgery procedures that offer patients the opportunity to succeed in their weight loss journey. Bariatric surgery helps to limit food intake, restrict nutrient absorption, or both. 

To qualify for insurance coverage for weight loss surgery, the patient must have a body mass index (BMI) of 40 or more (which translates to about 100 pounds overweight for men and 80 pounds overweight for women) OR a BMI between 35 and 39.9 with at least one serious obesity-related health issue such as heart disease, type 2 diabetes, severe sleep apnea, hypertension, debilitating joint pain or uncontrolled acid.

By the time patients seek weight loss surgery, they typically have tried other weight loss methods over the years without success.

To prepare for weight loss surgery, a patient has to quit smoking, watch their diet, increase water intake, and be mentally prepared.

Weight Requirements that Qualify You for Insurance Coverage for Bariatric Surgery

While bariatric surgery can be a relatively expensive procedure, the Nicholson Clinic is committed to helping every patient who needs weight loss surgery. We offer one of the lowest self-pay prices in the country and have financing options available. Nicholson Clinic accepts most major insurance. 

The survey on insurance coverage criteria for bariatric surgery shows that 95% of companies have clearly defined policies covering laparoscopic and Roux-en-Y bypass surgery.

Most insurance companies cover bariatric surgery as long as the patient has a BMI of 35-39.9 with comorbidities or a BMI of 40 and fulfill the pre-op requirements.

To work with your insurance provider to pay for your bariatric surgery, they generally require patients to:

  • Be 18 years and above
  • Have a BMI of 35 with a diabetes-related or serious obesity-related health issue, or BMI of 40 and above 
  • Produce evidence of your past efforts to lose weight
  • Pass your psychological evaluation
  • Have no history of drug and substance abuse
  • Quit smoking and drinking alcohol

Coverage for your weight loss surgery is dependent on your specific insurance plan, however Nicholson Clinic’s insurance specialist will work with you and your insurance provider to help you minimize your out-of-pocket expense and maximize coverage for your procedure.

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