What would make bariatric surgery medically necessary?

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.

Will insurance cover weight loss surgery if medically necessary?

Although you may meet standard and widely-accepted criteria for medical necessity, your insurance is not required to cover bariatric surgery. If weight loss surgery services are listed as an exclusion, your insurance will not consider you for coverage, irrespective of your BMI and comorbid conditions.

How do I convince my doctor I need bariatric surgery?

Ask your primary-care doctor or gynecologist for a referral to a weight loss surgeon. They’ll likely have patients who have undergone weight loss surgery, seen their success, and can help guide your choice of surgeon.

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 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.

Who Cannot have bariatric surgery?

Even if you are approved for bariatric surgery, it could potentially be delayed or canceled if your team of doctors finds: You are not psychologically or medically ready for surgery. You have not made appropriate diet or exercise changes. You have gained weight during the evaluation.

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.

Does gastric bypass shorten life span?

The 30-day mortality rate following bariatric surgery has been reported to range from 0.08 to 0.22%,19 but the risk for some subgroups of patients may be much higher2022. In a case series of 1,067 patients having open gastric bypass, those older than 55 years of age had a 3-fold increase in perioperative mortality22.

How can I get my insurance to pay for bariatric surgery?

How to get weight loss surgery covered by insurance

  1. Be over the age of 18.
  2. Have a BMI of 40 or greater, or have a BMI of 35 or greater with a comorbidity such as diabetes or hypertension.
  3. Diagnosis of morbid obesity.
  4. Pass a psychological evaluation determining you’re emotionally fit to undergo weight loss surgery.
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How long does it take United Healthcare to approve bariatric surgery?

This process takes approximately 30 days. After your insurance has authorized the surgery, you will then undergo a pre-operative education class to educate and remind you on than necessary nutritional and behavior that you should adopt, before and after the surgery.

How can I get help to pay for bariatric surgery?

Thankfully, there are six financing options available to help make the cost more manageable.

  1. Secured medical loan. According to Bariatric Surgery Source, one common source of financing is a secured medical loan. …
  2. Hospital payment plan. …
  3. 401(k) loan. …
  4. CareCredit. …
  5. Health savings account. …
  6. Personal loan.