Insurance and Qualifying
Cutting through the red tape of surgical weight loss
In 1991, as bariatric surgery became increasingly recognized as the most effective means of long term weight control, the National Institute of Health set out to define degrees of obesity, and determine who might be an appropriate candidate for surgical weight loss treatment.
A multidisciplinary panel was assembled and concluded that medical treatment for obesity, including diets, exercise, medications, hypnosis, etc. was effective for achieving long-term weight control in less than 5 percent of very obese patients. The panel also concluded that while surgical weight loss treatment is associated with some additional risks, it is much more effective at achieving and sustaining long-term weight reduction in morbidly obese patients than are other methods.
The panel’s recommendations have led to the following criteria for selecting candidates for bariatric surgery:
Weight Loss Surgery Candidate Criteria
Candidates for surgical weight loss must have failed in at least one valid attempt at medical weight loss treatment.
Bariatric surgery candidates will typically have one or more of the following:
- 100 lbs or more over ideal body weight (as determined by 1983 Metropolitan Life tables).
- Have a Body Mass Index (BMI) of 40 or greater.
- Be at least 75 lbs over their ideal body weight (or BMI over 35) with at least one serious obesity-related disease that is difficult to treat without weight loss.
Additionally candidates for surgical weight loss must:
- Be free of drug and alcohol dependence.
- Not currently pregnant.
- Be free of unstable psychiatric disorder or psychosis.
- Be between ages 18 and 65.*
*Candidates outside this age range must be evaluated for bariatric surgery on an individual basis.
Since 1991, many things have changed. The risk of surgery has dramatically improved and the number of people undergoing surgery has increased substantially. Many insurance companies and businesses have come to recognize the cost benefit of supporting bariatric surgery. New procedures have become more common while some older ones are no longer performed. Suffice to say, this is not a stagnant field of medicine!
In order for our office to determine if your policy covers bariatric surgery we will need to get some information from you. First please fill out the below insurance verification form or contact us information.
You will also be offered an appointment for a one on one consultation with Dr. Ayoola. As a part of this consultation, we will go over your insurance benefits and the specific criteria that you have to meet to qualify for bariatric surgery. Our staff has a vast knowledge of most insurance companies’ criteria that need to be met before your insurance company will grant approval.
For patients who do not have insurance that will cover bariatric surgery, we offer very competitive pricing. Our surgery packages start as low as $4,950.00. We also work with a financing company to help our patients with any out of pocket expense.
Some insurance companies require one or more of the following information:
- A letter from the patient stating all past weight loss attempts (walking around the block, Weight Watchers, Phen-fen, the cabbage soup diet, etc.)
- A letter of medical necessity from your primary doctor.
- 5 Years of medical records (to show a history of obesity)
- Psychological evaluation
- Documented medically supervised weight loss programs are often required.*
*If your insurance policy requires a medically supervised weight loss program, we can assist you in meeting these criteria.
Some of our contracted insurance companies:
Contact Us with Questions or to set an appointment