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How to determine if you’re eligible for bariatric surgery

Main Line Health November 12, 2019 Nutrition and Weight Management

Bariatric surgery has helped thousands of people meet their weight loss goals, drastically improve their overall health, and extend their lifespans.

That said, bariatric surgery isn’t always the best weight loss option for everyone. What works for one body will greatly differ from what works for another.

At Main Line Health, we’re committed to identifying which medical weight loss procedure is ideal for you and your body. We’ll help you determine if you’re eligible for weight loss surgery or if you’re better suited for another type of non-surgical medical weight loss procedure.

For more information or to schedule a consultation, call 484.476.6230.

Join us for an upcoming bariatric surgery information session

Criteria for weight loss surgery

To determine your eligibility for bariatric surgery, the first qualification we’ll look at is your body mass index (BMI), which is a measure of body fat based on height and weight.

Although a BMI of >25 to >30 is considered to be overweight, you must have a BMI of >40 to be eligible for weight reduction surgery. If you have another health condition, such as diabetes, irregular cholesterol, high blood pressure or sleep apnea, then a BMI of 35–39.5 will be accepted for surgery.

A BMI that falls within this range is just one of the weight loss surgery requirements that’ll help determine your eligibility.

“BMI is a screening tool, not a diagnostic of the health of the patient. Health care providers need to perform appropriate health assessments in order to evaluate an individual’s health status and risk,” says Michele Radaszewski, bariatric program manager at Main Line Health’s Bariatric Center.

Main Line Health’s eligibility assessment

Our specialists at Main Line Health will perform a comprehensive assessment to understand your health and determine if bariatric surgery is right for you. We’ll evaluate your nutrition and weight history along with any medical conditions that could potentially interfere with the success of your surgery. Depending on your insurance provider, you may also need to undergo a pulmonary, gastrointestinal, endocrine or cardiac evaluation.

Our psychologists will also assess your mental and emotional wellbeing. While a psychological disorder likely won’t disqualify you from being eligible for bariatric surgery, our team will address any issues that may emerge or worsen due to weight loss surgery.

Finally, our team will assess your determination and willingness to commit to a long-term lifestyle change. Bariatric surgery isn’t a quick fix, and it’s important for each patient to understand the diet and exercise obligations that follow surgery.

Navigating bariatric surgery requirements

In many cases, you need to have unsuccessfully attempted to lose weight via diet and exercise to be approved for surgery. In fact, certain insurance providers may require proof that you underwent a medically supervised weight loss program for three to six months. If this is the case, we’ll help you fulfill these requirements and paperwork in order to facilitate your approval for weight loss surgery.

Each health insurance provider has different criteria for determining your need for bariatric surgery. While it can be tricky and time-consuming to understand what your provider does or doesn’t cover, Main Line Health offers financial counseling to any patient who has questions or concerns about the costs and criteria for weight loss surgery.

“Our office assists all patients with verifying their coverage and reviewing the specific criteria required by that insurance company for them to be approved,” Radaszewski adds.

If you’re trying to sort through the benefits your insurance provider offers, Radaszewski suggests using bariatric procedure codes. (The code for gastric bypass is 43644, the code for a vertical sleeve procedure is 43775, and the code for a duodenal switch procedure is 43659.) Knowing your chosen procedure’s code before jumping on a call with your provider can decrease the time it takes to understand your coverage.

While navigating your eligibility can seem daunting, rest assured that the bariatric team at Main Line Health is prepared to walk you and your loved ones through all the necessary requirements for weight loss surgery.

About the Comprehensive Weight and Wellness Program

Main Line Health’s Bariatric Center is part of our Comprehensive Weight and Wellness Program, which was established to address the disease burden of obesity in our community. The program provides expertise in all evidence-based medical and surgical approaches to achieving a healthy weight, with a focus on helping patients reduce obesity-related health risks, improve overall health and quality of life, and commit to a healthy lifestyle.

The Comprehensive Weight and Wellness Program is under the leadership of metabolic and bariatric surgeon Richard Ing, MD, and obesity medicine specialist Stephanie McKnight, MD. In 2019, the center welcomed Samantha Witte, MD, metabolic and bariatric surgeon.

For more information or to schedule a consultation, call 484.476.6230.

Join us for an upcoming bariatric surgery information session