Gastric Bypass Surgery

Gastric Bypass Requirements – How to Qualify and Insurance

Gastric bypass requirements start with confirming that you have a body mass index (BMI) of at least 30 (if you have obesity-related health issues) or at least 40 (with no accompanying health issues required).

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Read below to learn everything you need to know about qualifying for the gastric bypass procedure.

01.

Gastric Bypass Qualifications For Insurance Approval

SECTION SUMMARY:

  • Obesity related health issues may be required for you to qualify

Gastric bypass requirements for insurance approval can take anywhere from one month to one year. The severity of your health issues may influence how long it takes to get approved. Be persistent and work with your insurance company to complete all gastric bypass surgery requirements.

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After you confirm that your insurance covers the procedure, the following steps will be required for insurance approval:

  1. Meet with a gastric bypass surgeon
  2. Complete lab work that includes an EKG and blood work testing
  3. Provide a comprehensive health history to your surgeon
  4. Obtain a mental health clearance letter. You’ll need to meet with a psychologist.
  5. Some insurance providers require meeting with a healthcare professional to discuss diet. You may be required to make a lifestyle plan and give diet/exercise one last try via a “medically supervised diet program.”

When these steps are completed you will submit paperwork to your insurance provider. The provider will review your information and send you a letter of approval or denial. If your request is denied, you may appeal their decision.

While the above may seem complicated, most surgeons will do all of the legwork for you. Contact a surgeon to start the process.

02.

Gastric Bypass Without Insurance

SECTION SUMMARY:

  • It is a faster process to get approved for surgery without insurance
  • The cost of gastric bypass without insurance ranges from $12,000 to $30,000

Not everyone can afford paying out-of-pocket for gastric bypass, but there are a few perks for anyone who can. Benefits include:

  • Choose any surgeon. You will not be required to choose in-network providers.
  • Less hassle. Dealing with insurance for weight loss surgery can be complicated. However, most surgeons’ offices will handle all interactions with your insurance company either way.
  • Therapy and psychological evaluations are not required.

If you’re interested in paying out of pocket for gastric bypass but feel it’s too expensive, you may consider international options. See our page on Weight Loss Surgery in Mexico for more affordable options.

03.

Gastric Bypass Disqualifications

SECTION SUMMARY:

  • If your BMI is not high enough, you likely won't qualify
  • Certain health issues you have can prevent having the surgery

The gastric bypass is an invasive surgery reserved for obese persons with a BMI of at least 30 (sometimes 35). If you struggle with weight but are not considered “obese”, this procedure is not for you.

Additional reasons you may not meet gastric bypass requirements include:

  • Plan to get pregnant within the next 12 months
  • Being treated for cancer
  • Unwilling to make lifestyle changes after surgery
  • Malignant hyperthermia (allergy to anesthesia medication)
  • Inflammatory disease or condition of the gastrointestinal tract, such as ulcers, severe esophagitis, Barrett’s esophagus, or Crohn’s disease
  • Cirrhosis
  • Severe mental health disorders or suicide attempts within the last 12 months
  • Active substance abuse disorders
  • Unwilling to quit smoking (best practice is quitting smoking 2 months prior to surgery)
  • Have never attempted weight loss through diet

If you have any of the above issues, contact a weight loss surgeon to discuss your options.

For a list of frequently asked questions about qualifiers (and disqualifiers), see our page “Do I Qualify For Weight Loss Surgery?”

04.

Options If You Don’t Qualify for Gastric Bypass

SECTION SUMMARY:

  • You could qualify for the gastric balloon procedure
  • The gastric balloon is an outpatient procedure done in 30 minutes or less
  • The gastric balloon results in meaningful weight loss, although not as much as gastric bypass
  • There are 3 Types of balloons to choose from (see below for details)

If you don’t meet gastric bypass requirements, the gastric balloon may be a good option.

During the gastric balloon procedure, a deflated silicone balloon is swallowed or inserted in the stomach. The balloon inflates when it reaches the stomach. This reduces the area in the stomach and makes patients feel full sooner.

See our page on Gastric Balloon for more information.

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05.

Patient Community & Expert Advice

SECTION SUMMARY:

  • You can read about other patients' experiences qualifying for gastric bypass
  • You can "Ask the Expert"

If you still have questions about gastric bypass requirements, our experts are happy to answer them. We (and other patients) would also love to hear about your experiences.

Please use the form below to share your experience or ask a question.

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Gastric Bypass Diet PDF and High BMI Risks*

I know that sometimes in order to get the benefits of bariatric surgery you need to follow the pre op before and after diet. I downloaded a gastric bypass diet…

06.

Find a Weight Loss Surgeon

SECTION SUMMARY:

  • You can ask a local bariatric practice for a free insurance check or cost quote
  • You can attend a free in-person seminar or an online webinar offered by a local weight loss surgeon
  • You should schedule a phone or in-person consultation (both often free), if you are interested in learning more about weight loss surgery

Search the surgeon directory below, click a listing, and contact a local surgeon:

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* 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