The first step is to make sure your plan has a "bariatric surgery benefit." This is particular coverage in your plan for weight loss surgery. Alternatively, make sure there is no "exclusion" for bariatric surgery in your plan. 

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Generally, candidates must have a Body Mass Index (BMI) of 40 or higher. You can also qualify if you have a BMI of 35 or above if you also have "obesity-related health conditions," such as type 2 diabetes, hypertension, sleep apnea, Non-Alcoholic Fatty Liver Disease (NAFLD) or Non-Alcoholic Steatohepatitis (NASH), elevated cholesterol, Polycystic Ovary Syndrome (PCOS), and some others. 

 

Insurance providers sometimes require documented proof of unsuccessful weight loss attempts through supervised diet and exercise plans, often within the past year. Additionally, many insurers mandate a pre-surgery psychological evaluation, nutritional counseling sessions, and medical clearances from other healthcare providers to confirm physical readiness for surgery. 

 

Meeting these requirements can take time, so working with Dr. Siegal early in the process can streamline approval, helping you stay on track toward achieving your health goals.

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If you are unsure if you qualify or have coverage, give us a call!