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Am I a candidate for weight loss surgery?

Am I a candidate for weight loss surgery?

Question Below Submitted By:  

Kellie (a patient from Bloomington, MN)

Am I a candidate for weight loss surgery? I’m in a women’s group and three of us (ironically) are considering weight loss surgery. I’m looking to gather information for us as a group. Here are the questions I’m hoping to get answers to:

  • How do you know if you’re a candidate?
  • What weight do you need to be in order to qualify?
  • Are there any health conditions that affect our ability to qualify?

Any additional information about qualifying is appreciated!

Thanks,
Kellie

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01.

Expert Responses to the Question Above

Surgeon Response To: Am I candidate for weight loss surgery?

by: Dr. John Rabkin

Kellie,

In order to qualify for Weight Loss Surgery (WLS) a prospective patient must be "morbidly obese." This is defined by having a Body Mass Index or BMI (which is a ratio of one's height to weight) of 40 or greater or 35 or greater when one or more of the obesity related medical problems such as diabetes mellitus, obstructive sleep apnea, or high blood pressure are also present. Your BMI can be readily calculated using available on-line BMI calculating tools. For certain available WLS procedures (LapBand) having one or more of those medical problems along with a lower BMI of 30 or greater will qualify a patient for WLS.

Every prospective WLS patient needs to be fully counseled and individually evaluated to assess their suitability to proceed with WLS: WLS is NOT for everyone. In certain situations, despite 'qualifying' for WLS based on the criteria outlined above, it would not be in a given patient's best interest to undergo WLS. An example is if a patient has pre-existing medical problems such as heart or lung failure that would make surgery too risky for that given patient. Another example would be a patient who wouldn't agree to comply with the necessary aftercare. For example, patients must keep in mind that WLS is a 'tool' to help patients lose weight and that the surgical procedure itself without active participation of the patient in the entire WLS program cannot be considered a 'cure' for obesity.

My recommendation is that you along with your other women's group members seek out and participate in a WLS informational seminar available or support group in your local community. This will also provide you and the others of your group the opportunity to meet with patients who have already undergone WLS and can share with you their experiences to help guide your WLS decision making.

John M. Rabkin, M.D.
Pacific Laparoscopy

(click here for Dr. Rabkin's full bio & contact info)

DISCLAIMER: This educational advice is based on the depth of your question and the details provided. The above should never replace the advice of your local physicians as they have the ability to evaluate you in person.

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Do You Qualify for a Bariatric Procedure?

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Do You Qualify for a Bariatric Procedure?

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Do You Qualify for a Bariatric Procedure?

Patients who qualify for bariatric surgery usually:

  • Are at least 80 lbs (36 kg) overweight
  • Are between 18 and 75 years old
  • Have a history of failed weight loss attempts (e.g., failed diets)
  • Thoroughly understand that the procedure is just a tool; long-term success requires significant diet and lifestyle changes

The minimum bariatric surgery qualifications include:

  • A body mass index (BMI) of 40 or more
  • OR a BMI between 30 and 39.9 with a serious obesity-related health problem like diabetes, high blood pressure, sleep apnea, high cholesterol, joint problems, or others
  • OR a BMI of 30 to 40 with or without health issues for the gastric balloon procedure

To calculate your BMI, enter your height and weight into the tool, then click the “Calculate BMI” button.

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Check My Insurance Tool

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Check My Insurance Tool

Bariatric surgery insurance coverage varies by insurance policy:

Individual/Family Plans & Small Group Plans – Coverage varies by state; coverage is required by the Affordable Care Act in some states

Large Group Plans – Coverage depends on whether your employer has chosen to add it to your policy

Medicare and Medicaid – Bariatric surgery is covered

If your policy covers it and you meet the qualification requirements, your plan will likely include 4 procedures:

  • Gastric sleeve
  • Gastric bypass
  • LAP-BAND®
  • Duodenal switch

Your surgeon may be able to get partial coverage for the other procedures.

Use the tool to find out if your insurance covers bariatric surgery.

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Bariatric Surgery Weight Loss Estimator Tool

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Bariatric Surgery Weight Loss Estimator Tool

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Bariatric Surgery Weight Loss Calculator

You will start losing weight fast after any bariatric surgery procedure, but the total amount lost varies based on:

  • The procedure you choose
  • How closely you follow your doctor’s instructions

Enter your information into the tool to get an idea about how much weight you’ll lose after each procedure.

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Bariatric Procedure Cost Compare Tool

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Bariatric Procedure Cost Compare Tool

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Bariatric Procedure Cost Compare Tool

Your out-of-pocket bariatric surgery cost can range anywhere from $0 to $20,000 or more depending on several factors, including:

Whether your insurance covers it – many insurances (including Medicare, Medicaid, and many individual/family and employer-provided policies) cover the majority of costs for gastric sleeve, gastric bypass, LAP-BAND®, and duodenal switch. The other types of bariatric surgery are less likely to be covered, although you may be able to get insurance to pay for some of the costs. Tap the “With Insurance” button in the tool to see average out-of-pocket costs per procedure after insurance pays. See our Insurance Tool to find out if your plan covers it.

Which procedure you choose – if insurance won’t pay, costs range anywhere from $8,000 to $20,000+, depending on the procedure. Tap the “Without Insurance” button in the tool to compare the national average self-pay costs for each procedure. (NOTE: Some surgeons offer each procedure for as low as half of the national average).

How competitive your surgeon and hospital fees are – there is often a substantial difference in costs between different doctors and hospitals, even within the same town.

Whether you qualify for tax write-offs – Bariatric surgery is tax deductible, which can have a big impact on the total cost of surgery. You can deduct medical expenses if your out-of-pocket costs are more than 10% of your adjusted gross income. See our Tax Tool to find out if your bariatric procedure will be tax deductible.

How you choose to pay for your procedure – If insurance covers it, you’ll only be responsible for any copays, deductibles, and coinsurance required by your specific plan. If you pay for the procedure without insurance, total costs will depend on how you pay. For example, your surgeon may offer a discount if you pay the full amount up front, and you can make the costs more affordable by applying for bariatric surgery financing.

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LOAN ESTIMATOR TOOL

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Bariatric Surgery Tax Write-Off Calculator

Weight loss surgery is tax deductible, which can have a big impact on the total cost of surgery. You can deduct medical expenses if the costs are more than 10% of your adjusted gross income.

Use the tool to find out if you qualify for a tax deduction.

To receive the deductions, you’ll need to complete Schedule A of the IRS Form 1040. You’ll also need to save your medical bills and payment statements as proof. Money in one of the following special savings accounts (or even your IRA) may also be a way to pay for part of surgery tax-free:

  • Health Savings Account (HSA)
  • Archer Medical Savings Account (Archer MSA)
  • Health Reimbursement Account (HRA)
  • Flexible Spending Account (FSA)
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Bariatric Surgery Tax Write-Off Calculator

Weight loss surgery is tax deductible, which can have a big impact on the total cost of surgery. You can deduct medical expenses if the costs are more than 10% of your adjusted gross income.

Use the tool to find out if you qualify for a tax deduction

To receive the deductions, you’ll need to complete Schedule A of the IRS Form 1040. You’ll also need to save your medical bills and payment statements as proof.

Money in one of the following special savings accounts (or even your IRA) may also be a way to pay for part of surgery tax-free:

  • Health Savings Account (HSA)
  • Archer Medical Savings Account (Archer MSA)
  • Health Reimbursement Account (HRA)
  • Flexible Spending Account (FSA)
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Bariatric Surgery Recovery Timeline Tool

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Bariatric Surgery Recovery Timeline Tool

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Bariatric Surgery Recovery Timeline Tool

Bariatric surgery recovery varies by procedure. Here are the ranges:

  • Timeline Range: from 3 days to 6 weeks to full recovery
    • Hospital Stay: from outpatient (return home same-day) to 3 days
    • Back to Work: from 3 days to 3 weeks
  • Pain Range: from mild discomfort to manageable with medication
  • Diet Range: from no restrictions to slow transition from clear liquids to solid foods
  • Activity Range: from no restrictions to slow transition back to regular activity and exercise

Use the tool to learn more about each stage of recovery.

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Bariatric Procedure Summaries

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Below is a brief explanation of how each bariatric surgery procedure works. Tap the icons for more information.

Bariatric Procedure Summaries

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Below is a brief explanation of how each bariatric surgery procedure works. Tap the icons for more information.

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Bariatric Procedure Comparison Tool

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Bariatric Procedure Comparison Tool

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Bariatric Procedure Comparison Tool

There are 6 types of bariatric surgery (also called “weight loss surgery”) available, including:

  • Gastric Sleeve – feel less hungry & full sooner while eating
  • Gastric Bypass – feel full sooner while eating & absorb fewer minerals
  • Duodenal Switch – feel less hungry & full sooner while eating, absorb fewer calories and minerals
  • LAP-BAND® – feel full sooner while eating
  • Gastric Balloon – temporarily feel full sooner while eating (balloon removed after 6 months)
  • AspireAssist – drain a portion of stomach contents after eating

Use the tool to compare each procedure.

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Bariatric Surgery Quiz: Learn Your Top 2 Procedures

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Bariatric Surgery Quiz: Learn Your Top 2 Procedures

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Bariatric Surgery Quiz: Learn Your Top 2 Procedures

The best weight loss surgery options for you depend on:

  • How much weight you want to lose
  • Your current age, weight, health issues, habits, and lifestyle
  • Your expectations for life after surgery
  • Whether you want a reversible procedure
  • What “trade-offs” you are willing to make

Take the quiz to find out which two procedures are best for you and why.

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Bariatric Surgery Health Benefits Tool (Gastric Sleeve)

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Bariatric Surgery Health Benefits Tool (Gastric Sleeve)

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Bariatric Surgery Health Benefits Tool

Bariatric surgery “cures” or significantly improves many obesity-related health conditions, including:

  • Diabetes
  • Sleep apnea
  • Hypertension
  • Joint issues
  • … and many others

Select your health conditions in the tool, then click the Submit button to find out the impact a procedure like gastric sleeve can have.

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[ Last editorial review/modification of this page : 08/22/2018 ]

* Disclaimers: Content: The information contained in this website is provided for general information purposes and your specific results may vary depending on a variety of circumstances. It is not intended as nor should be relied upon as medical advice. Rather, it is designed to support, not replace, the relationship that exists between a patient/site visitor and his/her existing physician(s). Before you use any of the information provided in the site, you should seek the advice of a qualified medical, dietary, fitness or other appropriate professional. Advertising: Bariatric Surgery Source, LLC has entered into referral and advertising arrangements with certain medical practices, original equipment manufacturers, and financial companies under which we receive compensation (in the form of flat fees per qualifying action) when you click on links to our partners and/or submit information. This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply. Read More

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