Do I Qualify For Weight Loss Surgery? Frequently Asked Questions
“Do I Qualify For Weight Loss Surgery?” It depends on your:
- Body Mass Index (BMI)
- Obesity-related health conditions
Your BMI needs to be at least 30 to qualify for weight loss surgery. If your BMI is under 40, some bariatric procedures require you to have obesity-related health conditions in order to qualify.
Use the tool below for a preliminary test to see if you qualify, then scroll down to learn more.
Do You Qualify for Weight Loss Surgery?
Do you have any health conditions related to your weight? Weight-related health conditions include arthritis, asthma, depression, joint/bone pain, migraines, high blood pressure, sleep apnea, and many others.
Do you qualify for a weight loss procedure?
TABLE OF CONTENTS
- Frequently Asked Questions: Qualifying For Weight Loss Surgery
- How To Get Approved By Insurance
- Find a Surgeon
Frequently Asked Questions: Qualifying For Weight Loss Surgery
See below for common questions about how to qualify for bariatric surgery:
- I have a BMI above 30. What else do I need to know about qualifying?
- I know I qualify for weight loss surgery, but is it the right choice for me?
- Should I purposely gain weight in order to qualify for weight loss surgery?
- I know I qualify for weight loss surgery, but which procedure is right for me?
- I’m under 18. Can I still qualify for bariatric surgery?
- I’m over 65. Can I still qualify for bariatric surgery?
HEALTH, DIET, & LIFESTYLE
- What health conditions disqualify me from weight loss surgery?
- Will the medications or supplements I take disqualify me from having bariatric surgery?
- I want to have kids. Can I still qualify for weight loss surgery?
- Do I need a psychological assessment to qualify for weight loss surgery?
- I have an alcohol problem. Do I still qualify for weight loss surgery?
- I smoke cigarettes. Do I still qualify for bariatric surgery?
- I won’t be able to exercise after surgery, can I still qualify?
PREVIOUS WEIGHT LOSS SURGERY PATIENTS
- How do I figure out if my insurance covers the procedure I want?
- I want weight loss surgery, but I don’t have health insurance. Can I still qualify?
- I want surgery in Mexico. Are the bariatric surgery qualifications different in Mexico?
- My insurance doesn’t cover weight loss surgery. Are there any ways to make it more affordable?
I have a BMI above 30. What else do I need to know about qualifying?
If your BMI is between 30-34:
- You qualify for the gastric balloon procedure
- You may qualify for other procedures like gastric sleeve or gastric bypass if you have health issues related to your weight, also known as “comorbidities.” Your odds of qualifying will increase if you have a combination of conditions. A few of the most common obesity-related health conditions include diabetes, hypertension, joint problems, and sleep apnea.
- Some surgeons will not accept patients with BMI’s below 35, and most insurance companies, including Medicare, will not cover bariatric procedures for patients with BMI’s below 35.
If your BMI is between 35-39:
- You qualify for gastric balloon, vBloc Therapy, and AspireAssist.
- You qualify for gastric sleeve, gastric bypass, LAP-BAND®, and duodenal switch only if you have a serious obesity-related health condition like diabetes, sleep apnea, hypertension, or many others.
- If your insurance covers bariatric procedures, your policy will only include coverage for gastric sleeve, gastric bypass, Lap-Band, and duodenal switch. However, you may be able to get some of the costs covered for gastric balloon, vBloc Therapy, and AspireAssist on a case-by-case basis.
If your BMI is 40 or above:
- You automatically qualify for most types of weight loss surgery. Additional obesity-related health conditions are not required.
- If your insurance covers bariatric procedures, your policy includes coverage for gastric sleeve, gastric bypass, Lap-Band, and duodenal switch. You may be able to get some of the costs covered for gastric balloon, vBloc Therapy, and AspireAssist on a case-by-case basis.
See our Types of Weight Loss Surgery page for more information.
I know I qualify for weight loss surgery, but is it the right choice for me?
Weight loss surgery patients usually lose significant weight and improve their quality of life. However, this knowledge won’t take away the nervous energy you may feel when deciding if surgery is right for you.
If you’re concerned about safety, know that weight loss surgery has a 99.9% survival rate. Like all surgeries, there is a risk of side effects and complications, but the benefits of surgery are much greater than the risk of remaining obese.
To decide whether it’s right for you, ask yourself:
- Have you thoroughly explored other treatment options, including strict diet and exercise programs?
- Do you have the means or insurance to pay for treatment?
- Do your expectations of life after weight loss surgery match reality?
- Are you willing to do whatever it takes, including significant diet and lifestyle changes, in order to be successful?
Should I purposely gain weight in order to qualify for weight loss surgery?
If you want weight loss surgery but your BMI isn’t high enough, you may find yourself considering weight gain in order to qualify. This isn’t an ideal way to qualify for weight loss surgery, but some prospective patients struggle with this predicament. You may have other options.
Your first step is to contact a reputable surgeon and discuss your options. They will work with your insurance company on your behalf to find out if an exception can be made.
If you insurance declines your request, you have the right to appeal your denial. See our page on Health Insurance Appeals for more information.
If you don’t qualify because you’re not diagnosed with an obesity-related health condition, but your BMI is above 30:
I know I qualify for weight loss surgery, but which procedure is right for me?
The right weight loss procedure for you depends on your preferences and weight loss goals. Your options include:
Take our Weight Loss Surgery Quiz for help finding a procedure you feel good about.
I’m under 18. Can I still qualify for bariatric surgery?
Yes. Not all surgeons operate on adolescents, but there are many quality providers available. See our section on adolescent weight loss surgeons for a list of providers closest to you.
I’m over 65. Can I still qualify for bariatric surgery?
Yes, you can qualify. Patients over the age of 65 have to meet the same requirements as everyone else; there are no additional qualifiers for patients over 65.
See our section on Bariatric Surgery for patients over 65 to learn more about the safety of surgery in this age group
HEALTH, DIET, & LIFESTYLE:
What health conditions disqualify me from weight loss surgery?
- Having very high operative risks like severe heart or lung disease
- Current infection
- Severe mental health disorders that impair a patient’s ability to comprehend the nature of surgery
- Diseases that affect the gastrointestinal tract like ulcers, severe esophagitis, Barrett’s esophagus, or Crohn’s disease
- Portal hypertension
- Abnormal esophagus, stomach, or intestine
- Chronic pancreatitis
- Long-term steroid treatment
- Not willing to follow long-term diet, vitamin, or exercise regimen
- Autoimmune connective tissue disease
- Recent suicide attempts
Will the medications or supplements I take disqualify me from having bariatric surgery?
Medications and supplements rarely disqualify a patient from weight loss surgery. The most common concern is any agent that thins the blood, which usually warrants a change made by your doctor.
You will give your surgeon a comprehensive list of all medications, supplements and vitamins that you take. Again, it is uncommon that medications interfere with your qualification, but having this conversation with your surgeon is an important part of the screening process.
I want to have kids. Can I still qualify for weight loss surgery?
Yes, but female patients are advised to wait 18 months before trying to get pregnant. The body needs this time to adjust to surgery and establish a new weight range.
See our Pregnancy After Weight Loss Surgery page for more information.
Do I need a psychological assessment to qualify for weight loss surgery?
Yes. Here’s why:
Weight loss surgery requires significant lifestyle changes in order to achieve long-term success. Social workers will meet with you to confirm you’re mentally ready to make the changes necessary.
You also need to be screened for food addiction. Food addictions should be addressed before surgery in order to reduce the risk of weight regain after surgery. See our page on Food Addiction Treatment for more information.
I have an alcohol problem. Do I still qualify for weight loss surgery?
If you have an active alcohol problem, you won’t qualify (yet). When you can demonstrate a period of sobriety, your surgeon will likely approve your surgery. Additional testing on your liver may be required.
It is recommended that you avoid alcohol after surgery. Not only is alcohol loaded with unhealthy sugars and calories that contribute to weight gain, but you may respond differently when drinking after surgery. Alcohol use after weight loss surgery may contribute to unintended health consequences.
See our page on Alcohol after Bariatric Surgery for more information.
I smoke cigarettes. Do I still qualify for bariatric surgery?
You can still qualify, but not all surgeons will operate if you’re a frequent smoker. You will need to ask your surgeon ahead of time.
I won’t be able to exercise after weight loss surgery. Can I still qualify?
If you have mobility issues that impair your ability to exercise, you still qualify for weight loss surgery. You can still lose significant weight after surgery by following bariatric eating guidelines.
PREVIOUS WEIGHT LOSS SURGERY PATIENTS:
I’ve already had weight loss surgery, can I qualify again?
Yes, this is called revisional surgery.
Some patients don’t lose as much weight as they’d like (or they regain weight) and wish to undergo another surgery. Revisional surgery can be an effective way to reach your weight loss goals.
If you’re interested in revisional surgery, learn more by visiting the page that applies to you:
How do I figure out if my insurance covers the procedure I want?
This information is included in your insurance policy documents. You can also call your insurance provider to ask about coverage. See our section on How To Get Approved By Insurance for more information on working with your insurance company.
I want weight loss surgery, but I don’t have health insurance. Can I still qualify?
Yes, you can still qualify for surgery, but you’ll need to figure out a way to pay for it. See our section on how to make weight loss surgery affordable for more information.
I want surgery in Mexico. Are the bariatric surgery qualifications different in Mexico?
The qualifications are less restrictive in Mexico. Differences include a shorter waiting period, no psychological evaluation, and comorbidities are usually not required. To learn more, see our page on Weight Loss Surgery in Mexico.
My insurance doesn’t cover weight loss surgery. Are there any ways to make it more affordable?
There are a few ways to make weight loss surgery more affordable, including:
- Applying for a medical loan with a monthly payment plan. The following chart is an estimate of monthly payments if you set up a four year payment plan:
Surgery Average Cost Without Insurance Your Monthly Payment Gastric Sleeve $19,000 $400 Gastric Bypass $24,000 $500 Duodenal Switch $27,000 $550 LAP-BAND® $15,000 $300
- Choose a less expensive non-surgical weight loss procedure:
Surgery Average Cost Without Insurance Your Monthly Payment Gastric Balloon $8,000 $175 Endoscopic Sleeve Gastroplasty $12,000 $250 AspireAssist $10,000 $200 vBloc Therapy $18,500 $375
- Consider finding a doctor outside of your area who is less expensive, including surgeons in other states or reputable practices in Mexico:
How To Get Approved By Insurance
Check with your surgeon
Use the tool below to see if your insurance company covers weight loss surgery:
Contact a top surgeon to request a free insurance check – most practices are happy to help you with this without requiring that you come into the office.
After your surgeon confirms coverage, you will schedule an in-person consultation to discuss your options. If you decide to proceed with treatment, your surgeon’s staff will help you through each step of the insurance process.
For example, your surgeon will schedule visits with the following medical professionals whose sign-off will be required by your insurance company:
- Your primary care physician – will send your surgeon a medical clearance letter.
- A mental healthcare worker – will send your surgeon a mental health clearance letter.
- A registered dietitian – will discuss your diet and previous attempts to lose weight and modify your current diet in an effort to help you lose weight before surgery. Most insurance companies will require you to participate in a 3 to 9 month (depending on your insurance company) medically supervised diet program prior to approving you for surgery. If you have not participated in one in the past, your surgeon’s dietitian will enroll you in their program.
After meeting with all of the healthcare professionals, your surgeon will send documentation from each visit to your insurance company. They will also include a detailed history of your obesity-related health problems, previous attempts at weight loss, and why you’re a good candidate for weight loss surgery.
The review process typically takes less than one month. The insurance company will then send you a letter of approval or denial. If approved, your surgeon’s bariatric coordinator will contact you for scheduling; if you are denied, you can choose to appeal the denial.
See our Bariatric Surgery Insurance page for more information.
Find a Surgeon
- Ask for a free insurance check or cost quote
- Attend a free seminar or webinar
- Schedule a phone or in-person consultation (both often free)