Criteria For Bariatric Surgery

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The following criteria must be met prior to bariatric surgery and will be adjusted to meet the guidelines set forth by the patient’s insurance carrier.

Statistical Requirements 

Body Mass Index (BMI)

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Gastric Banding

  • Patients must have a BMI of 50 or less at the time of surgery.

Gastric Bypass

  • Male patients must have a BMI of 55 or less at time of surgery.
  • Female patients must have a BMI of 60 or less at the time of surgery.
  • Both male and female patients with a BMI of 35 to 40 must have acceptable co-morbidities such as diabetes or sleep apnea to be approved for surgery and cannot have significant cardiac or pulmonary co-morbid conditions.

Age Criteria

  • The patient is 25 to 59 years of age. Patients 22 to 25 years of age may be considered on an individual basis.
  • Patients up to 59 years of age may be considered if medically acceptable. The patient must be less than 60 years of age at the time of surgery.

Health Criteria

  • Documented past dietary attempts at weight control have been ineffective and patient has failed to lose weight (approximately 10% from baseline) or has regained weight despite participation in weight reduction plans and exercise programs
  • Morbid obesity has persisted for the past 3 to 5 years
  • There is no treatable metabolic cause for the obesity 
  • Obesity has interfered with activities of daily living or ability to work 
  • No current or recent substance abuse problems

Pre-Surgery Clearances

  • The patient must complete a psychological evaluation by a licensed mental health professional and be recommended for bariatric surgery
  • The patient must receive cardiac clearance by a cardiologist if there is a history of prior phen-fen or redux use or underlying cardiac issue 
  • The patient must be evaluated for restrictive lung disease and received surgical clearance by a pulmonologist if there is a history of underlying pulmonary issue

Patients' Pre-Surgery Obligations 

  • Patient must comply with the recommended weight loss goal prior to surgery
  • Patient must have successfully stopped smoking at least two months prior to surgery
  • The patient must understand the surgical procedure, risks and possible complications

Patients' Post-Surgery Obligations

  • Following surgery, the patient must participate in a multidisciplinary program that will provide guidance on diet, physical activity and social support 

*Information will be submitted to the patient’s insurance carrier as outlined in their health plan and prior authorized received prior to the surgical treatment of morbid obesity.