Gastric Bypass Requirements - Qualifications and Insurance
Gastric bypass requirements start with confirming that you have a body mass index (BMI) of at least 30 (if you have health issues) or at least 40 (with no health issues). Use the calculator below to see if you meet the minimum gastric bypass qualifications.
TABLE OF CONTENTS
- Gastric Bypass Qualifications For Insurance Approval
- Gastric Bypass Without Insurance
- Reasons You May Be Disqualified
- Options If You Don’t Qualify for Gastric Bypass
- Patient Community & Expert Advice
- Find a Top Weight Loss Surgeon
Gastric Bypass Qualifications For Insurance Approval
Check My Insurance Tool
Obesity related health issues may be required
Use the tool below to find out if your insurance provider covers gastric bypass.
Gastric bypass requirements for insurance approval can take anywhere from one month to one year. The severity of your health issues may influence how long it takes to get approved. Be persistent and work with your insurance company to complete all gastric bypass surgery requirements.
The following are steps required for insurance approval:
- Meet with a gastric bypass surgeon
- Complete lab work that includes an EKG and blood work testing
- Provide a comprehensive health history to your surgeon
- Obtain a mental health clearance letter. You’ll need to meet with a psychologist.
- Some insurance providers require meeting with a healthcare professional to discuss diet. You may be required to make a lifestyle plan and give diet/exercise one last try via a “medically supervised diet program.”
When these steps are completed you will submit paperwork to your insurance provider. The provider will review your information and send you a letter of approval or denial. If your request is denied, you may appeal their decision.
While the above may seem complicated, most surgeons will do all of the legwork for you. Contact a top surgeon to start the process.
Gastric Bypass Without Insurance
Faster process to get approved
Cost ranges from $12,000 to $30,000
Not everyone can afford paying out of pocket for gastric bypass, but there are a few perks for anyone who can. Benefits include:
- Choose any surgeon. You will not be required to choose in-network providers.
- Less hassle. Dealing with insurance for weight loss surgery can be complicated. However, most surgeons’ offices will handle all interactions with your insurance company either way.
- Therapy and psychological evaluations are not required.
If you’re interested in paying out of pocket for gastric bypass but feel it’s too expensive, you may consider international options. See our page on Weight Loss Surgery in Mexico for more affordable options.
Gastric Bypass Disqualifications
BMI not high enough
Health issues can prevent surgery
The gastric bypass is an invasive surgery reserved for obese persons with a BMI of at least 30 (sometimes 35). If you struggle with weight but are not considered “obese”, this procedure is not for you.
Additional reasons you may not meet gastric bypass requirements include:
- Plan to get pregnant within the next 12 months
- Being treated for cancer
- Unwilling to make lifestyle changes after surgery
- Malignant hyperthermia (allergy to anesthesia medication)
- Inflammatory disease or condition of the gastrointestinal tract, such as ulcers, severe esophagitis, Barrett’s esophagus, or Crohn’s disease
- Severe mental health disorders or suicide attempts within the last 12 months
- Active substance abuse disorders
- Unwilling to quit smoking (best practice is quitting smoking 2 months prior to surgery)
- Have never attempted weight loss through diet
If you have any of the above issues, contact a top weight loss surgeon to discuss your options.
For a list of frequently asked questions about qualifiers (and disqualifiers), see our page “Do I Qualify For Weight Loss Surgery?”
Options If You Don’t Qualify for Gastric Bypass
One Other Weight Loss Procedure: Gastric Balloon
It is an outpatient procedures done in 30 minutes or less
Results in meaningful weight loss, although not as much as gastric bypass
3 types of balloons to choose from
If you don’t meet gastric bypass requirements, the gastric balloon may be a good option.
During the gastric balloon procedure, a deflated silicone balloon is swallowed or inserted in the stomach. The balloon inflates when it reaches the stomach. This reduces the area in the stomach and makes patients feel full sooner.
See our page on Gastric Balloon for more information.
Patient Community & Expert Advice
Ask the Expert
If you still have questions about gastric bypass requirements, our experts are happy to answer them. We (and other patients) would also love to hear about your experiences.
Please use the form below to share your experience or ask a question.
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I know that sometimes in order to get the benefits of bariatric surgery you need to follow the pre op before and after diet. I downloaded a gastric bypass diet…
Find a Top Weight Loss Surgeon
Search the surgeon directory below, click a listing, and contact the surgeon to:
- Ask for a free insurance check or cost quote
- Register to attend a free seminar or webinar
- Schedule a phone or in-person consultation (both often free)