How to get Approved for Weight Loss Surgery

Based on my discussions with different bariatric patients, it is very clear that not all paths to surgery are the same. We all have different journeys, different reasons for picking weight loss surgery, and there are at least three different surgeries you could pick from.

I’ll try to make a separate post about those as well, but keep in mind that I’m no expert or medical professional, so I am just sharing what I’ve learned so far as I’ve traveled down this road.

One thing is for certain, if you are going through insurance to get your weight loss surgery paid, you will have a few hoops to jump through. For a lot of us, they are the same, so I will go over those here.

The best thing to do if you need to know specifics of your insurance plan, is to contact your insurance company. Two people can have the same insurance plan through different employers, and one of those companies may choose not to cover bariatric surgery, so check first.

Common Insurance requirements:

Must be age 18 or older

Self-explanatory

Psychological Evaluation

I’ve seen this vary from a short conversation with a psychologist or psychiatrist, to a very in-depth session or multiple sessions.

I had a very casual conversation with a psychiatrist who asked me about my reasons for wanting weight loss surgery, and who would be my support system.

BMI of 40 or above (35 with co-morbid conditions)

There are several BMI calculators out there. A quick Google search will get you to one so that you can find out yours based on age and weight.

A BMI of 40 is considered morbid obesity so if this is where you find yourself, like I did, then you qualify for weight loss surgery based on that alone.

some people are not in the “morbid” category, but still obese and might consider surgery due to health reason, and that is where comorbidities come in.

What are comorbidities?

Co-morbid conditions are health issues you may have along being obese. Not all diseases will qualify you for weight loss surgery but if your BMI is at least 35, Blue Cross Blue Shield, which was my insurance at the time of surgery, will consider the following:

• Hypertension
• a cardiopulmonary condition.
• Sleep apnea.
• Diabetes mellitus;
• Any life threatening or serious medical condition that is weight induced

Structured Diet Program

While some plans do not require this (again check with your specific policy), my insurance company required documented weight loss attempts.

This is directly from the medical policy on their site:

“must complete a structured diet program in the 2-year period that immediately precedes the request for the surgery by participation in either: – one structured diet program for 6 consecutive months or

– two structured, diet programs for 3 consecutive months. (can include commonly available diet programs such as Weight Watchers® or Jenny Craig®)

Program Requirements

The following are requirements set by my specific bariatric center and can vary, just like the insurance requirements, depending on where you go.

Supervised Weight loss visits (either with a nutritionist or physician)

This could be program or insurance specific. In my case, my insurance only required that I have documented weight loss attempts following one structured diet 6 consecutive months or two structured diet plans for three months each within the last two years. 

As I mentioned a bit above, they counted programs such as WW (formerly Weight Watchers), Jenny Craig, Nutrisytem and similar plans.

Although I’d been dieting on and off for the better part of the last decade, I did not have consistent “documented” proof to show my insurance company.

So, I went with what my surgeon’s office calls “physician-supervised weight loss visits”, for six consecutive months, and that covered the diet requirement with the insurance company.

During my monthly visits, my doctor talked to me about different topics such as keto, the importance of protein, avoiding sugars, and tracking everything I eat. Basically, he was trying to prepare me for life after surgery, more than trying to get me to lose weight pre-op.

I’ve seen some people mention that they needed to lose X amount of weight prior to approval, but that was not the case for me. 

Labs, so many labs

I believe they drew about 10 (or more) vials of blood on my first visit. It shocked me because on that first visit in mind I was still in the research phase and definitely not committed.

It didn’t hurt to get a picture of my health so I went with it. Some things they checked, Nicotine (you have to stop smoking prior to surgery, if you are a smoker), pain killers( I forgot which substance exactly), All the vitamins, iron, electrolytes, thyroid, A1C, cholesterol, you name it.

I’m sure I’ve missed some, but basically if there was something to be looked at in your bloodwork, they looked at it. There was also a urinalysis.

Chest X-ray

This one consisted of exactly that, an Xray to view your lungs, heart, and chest walls

Nutrition Class

I only needed one group class via Zoom with a registered dietitian (R.D.), with the option to schedule up to 3 one-on-one sessions, but I opted out of those.

My R.D. was also available for questions via email, and I did message him with a questions a couple of times.

Gallbladder & Liver Ultrasound

They pay particularly close attention to your gallbladder. If there are any signs of gallstones or other issues, most bariatric surgeons will remove your gallbladder during surgery.

Sadly, mine was healthy. I say “sadly” because it had to come one 9 months after my duodenal switch procedure. I would have preferred to avoid another surgery and just have it removed all at once.

Cardiac Clearance

This consisted of an EKG, Stress test, Echocardiogram, and DVT scan ( a scan of your legs to check your veins and rule out clots/deep vein thrombosis).

All to make sure your heart can handle the surgery. Please note that having any heart conditions does not automatically disqualify you. I have a heart murmur, totally benign, except for the occasional bout of palpitations, and was cleared. Obv.

Sleep study

Most obese individuals have undiagnosed sleep apnea, a condition where you basically stop breathing for a few seconds while sleeping. Scary, I know. I was no exception.

All bariatric centers as far as I know require this. They also require that you use the CPAP machine given to sleep apnea patients, and to bring it with you and use while in the hospital.

I’d already had a sleep study a few weeks prior to my first appointment with my bariatric surgeon, and was also already using the CPAP. Happy to report I was cleared to stop using the machine at my 2 week post-op appointment. First Non Scale Victory of many!

Wrap-Up

Those were all of the requirements I personally had to go through in the 6 months prior to my surgery. Again, I am not a medical professional, and am just sharing my journey and personal experience.

I know insurance companies and bariatric surgeons have more or less requirements and your mileage may vary.

If you decide to undergo this process, good luck to you! I know it’s scary but so worth it in my opinion. I am 142lbs down as of today, 18 months post surgery, and so glad I did it.

Thanks for reading!