How do you prove bariatric surgery medically necessary?

Which criteria qualifies a patient for bariatric surgery?

To be eligible for weight-loss surgery, you must meet the following requirements: Have a body mass index (BMI) of 40 or higher, or have a BMI between 35 and 40 and an obesity-related condition, such as heart disease, diabetes, high blood pressure or severe sleep apnea.

How can I get my doctor to approve weight loss surgery?

Make an Appointment with Your Primary Care Physician

Tell your GP that you are interested in weight loss surgery and are seeking a referral. Discuss your present health conditions or any medications you are on and how these may be affected with surgery.

What medical conditions disqualify you for bariatric surgery?

These are as follows:

  • Drug and/or alcohol addiction.
  • Age under 16 or over 75.
  • History of heart disease or severe lung problems. …
  • Chronic pancreatitis (or have a history of this).
  • Cirrhosis of the liver.
  • Autoimmune disease such as systemic lupus erthyematosus.
  • Blood disorder which increases your risk of heavy bleeding.

Why was bariatric surgery denied?

While some patients may be denied coverage due to a clerical error or a technicality which can be overturned, other patients may not be deemed candidates for bariatric surgery by their insurance company and therefore not have coverage.

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How quickly can I get bariatric surgery?

Most patients can be pre-approved for bariatric surgery within a matter of 90 days/12 weeks (with consecutive office visits throughout) if there are no medical weight loss program requirements, but there is no guarantee.

Can I get gastric bypass if I’m not obese?

You must have a BMI of at least 27-30 to be considered for surgery. It’s important to note that your BMI doesn’t differentiate between your body fat and mass. This means bodybuilders and people who have lots of muscle will have a high BMI but aren’t overweight or obese.

How much weight do you have to lose before gastric sleeve?

Some patients are required to lose 10 percent of their weight before weight-loss surgery is performed. For other patients, losing just 15 to 20 pounds right before surgery is enough to reduce the risk of complications. It’s important to follow your surgeon’s pre-surgery diet and nutrition guidelines.

How long does it take insurance to approve bariatric surgery?

It can take two to four weeks for the insurance company to respond with a decision.

What do I need to take to the hospital for gastric bypass?

Bariatric surgery hospital checklist

  • Personal documents. …
  • Money and coin change It’s better to take your credit or debit card with you, for most of the expenses during your trip. …
  • Entertainment. …
  • Phone charger and extension cords. …
  • Headphones. …
  • Water spray. …
  • Lip balm and moisturizing creams. …
  • Wet wipes and Vaseline.