Insurance criteria varies depending on your health plan and benefits. There are a number of different plans available to a patient, and at times it becomes very confusing and difficult to choose which one fits your needs. Bariatric patient’s are required by their Insurance Company to undergo certain requirements prior to being granted a surgery authorization. Each health plan has different criteria, but most are similar to those listed below:
- A BMI of >35 with two co-morbidities (listed below) or a BMI of >40
- Medical History of Co-Morbidities associated with obesity (Diabetes Mellitus, Obstructive Sleep Apnea, Hypertension, Gastric Reflux Disease, Degenerative Joint Disease/Arthritis, Hypercholesterolemia, etc.)
- Medical history of Obesity for up to 5 years
- 3-6 months weight loss management (either by PCP/ Dr. Krahn/ Weight Loss Clinic) participated in within the last 2 years
- Nutritional consultation and assessment
- Psychological evaluation showing patient is willing to comply in a strict post-operative regimen
- Age ranging from 18-65
Not all insurance companies require the above criteria, although it is commonly seen in most. Our office staff is very knowledgeable and willing to assist you with understanding the insurance criteria of your health plan.
Please see our Insurance section for accepted coverage.
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