Surgical Process

Bariatric Surgery Candidates  |  Insurance Coverage  |  After Your Surgery

Bariatric Surgery Candidates

Qualifying for Bariatric Surgery

In order to be considered a candidate for bariatric surgery, a person generally has to be eligible by National Institute of Health guidelines established in 1991.
 
Patient must have a body mass index of 40 or greater OR patient must have a body mass index of 35 or greater with the presence of significant co-morbid conditions related to morbid obesity. Some of the co-morbid conditions are:

• Type II Diabetes
• Sleep Apnea
• Hypertension
• Coronary Artery Disease
• Metabolic Syndrome (Syndrome X)
• Patient can show that dietary attempts at weight control have been ineffective

They might also require psychiatric evaluation, extensive physical examination and testing, and assessment by a registered dietitian. Check with your benefit manual for specific coverage criteria and feel free to call us and ask us any questions you may have. You may also see our Insurance Coverage page for some of the specific details required by some of the area’s major insurance carriers.

Most bariatric surgeons will agree that surgery is needed on anyone who has a BMI greater than 30 with the presence of several obesity related conditions. While this would seldom be covered by insurance, most surgeons will accept a self-pay candidate under these conditions.

Bariatric Insurance Coverage

Most insurance companies offer benefits for bariatric surgery. Your employer selects your benefits and makes the decision to offer bariatric coverage. Your Benefits Handbook provided by your employer will list all of your benefits including benefits for bariatric surgery.

Nova Weight Loss will make every effort to accurately verify your benefits prior to your consultation if you have provided us with your complete insurance information at the seminar. Nova Weight Loss, however, can not be held responsible for information reported to us by your insurance company in error.
 
If a patient has another insurance than what is listed above, we can verify it to make sure bariatric surgery is a covered benefit
 
Over 90% of our clients are able to use their private insurance to cover their bariatric surgery. After the 1991 National Institute of Health Consensus conference, the federal government mandated coverage for all federal employees. This opened the door for most insurance carriers to investigate offering bariatric surgery coverage for their plan holders. In 2006, The Center for Medicare Services Administration standardized coverage for bariatric surgery for all Medicare and Medicare recipients.
 
With the increasing awareness of the benefits of bariatric surgery, the costs to the insurance providers have increased sharply. Many plans now have specific requirements that have to be met to allow access to coverage for surgery. It is worthwhile to note that bariatric surgery is the ONLY area of medicine to be subjected to this kind of scrutiny when predetermining coverage. Our staff has many years of experience working with the insurance companies and enjoy a high success rate of approvals for our clients.
 
Below is a brief listing of some of the larger insurance companies and their coverage criteria:

Universal Treatment Requirements:

• NIH criteria for surgical treatment of obesity:
• BMI greater or equal to 40 (80-100lbs overweight)
• BMI greater or equal to 35 with presence of severe co-morbid condition such as diabetes, hypertension, sleep apnea, or heart disease.

If you have a BMI below 35, your insurance will not provide coverage for surgery. However you may be considered for surgery on a self-pay basis.

After Your Surgery

Surgery is just the beginning of your journey toward better health. Our post-surgical program is equally as important for education and support. Nova Weight Loss understands the significance of a STRONG aftercare program. We have brought together a highly accomplished and qualified team to provide the best possible experience to help you achieve your goals. We have structured educational classes, as well as specialized instructions from each individual surgeon.

Our educational program focuses on the mechanics of eating, how to adapt to healthy eating, better food choices, and the interaction of nutrition with your body's metabolism. We have done extensive research on vitamin and protein supplements so that we can recommend the products that will work best for you, giving you ideas of how and when to use them.

Patients that have had the Lap band surgery will usually require adjustments to their band during the first year. Nova is pleased to provide expert care for these adjustments. We have a Fluoroscopic Imaging (X-ray) available and we offer nutritional guidance after each adjustment. We also offer competitive pricing for band adjustments for individuals that were unable to use their insurance benefits for this service.