Gastric sleeve surgery, also known as sleeve gastrectomy, is commonly performed on patients who are classified as morbidly obese and at high risk for weight-related health problems. During this laparoscopic surgery, a surgeon permanently removes 80-90% of your stomach, creating a tube or “sleeve” which can only hold a limited amount of food allowing patients to feel full and lose weight quicker. So, who is the best candidate for gastric sleeve surgery?
What are the minimum requirements for gastric sleeve surgery?
One of two basic requirements must be met to qualify for gastric sleeve surgery:
- Have a body mass index (BMI) of 40 or higher
- Have a BMI of 30-40 with serious weight-related health problems like diabetes, high blood pressure or heart disease
BMI is a formula that calculates the ratio of your height and weight and correlates to the amount of body fat you have. On average, a BMI of 40 is equivalent to being 100 pounds overweight for men and 80 pounds overweight for women.
What to do next if you qualify for gastric sleeve surgery
Once you determine that you meet the basic requirements for gastric sleeve surgery, the next step is to decide whether or not you will use insurance to cover the cost. You can contact your provider to see if gastric sleeve is covered under your plan and, from there, you can request more information about their coverage criteria and required documentation.
Most insurance companies cover bariatric surgery; however, their individual requirements may vary based on the type of surgery. With insurance, there is often a longer approval process and more requirements than private pay, so we recommend scheduling a consultation with us to learn more about your payment options.
What are some of the requirements for insurance approval of gastric sleeve surgery?
If gastric sleeve coverage is included in your insurance policy, then you will have to meet your provider’s criteria in order to obtain approval. Requirements often vary based on the provider. For example, some have significantly higher BMI requirements, but will lower the required number if lung or heart issues are also a factor.
The best thing to do is to request a list of your coverage criteria and begin collecting the necessary documentation as soon as possible. This may include proof that you have undergone a medically supervised diet program prior to surgery or a letter of medical necessity. A psychological evaluation may also be required before approval for surgery is granted.
At Birmingham Minimally Invasive Surgery, we will work with you and your insurance provider to make sure you obtain all of the necessary documentation to meet your provider’s specific requirements.
What are some reasons you may not qualify for gastric sleeve surgery?
There are cases that may make you ineligible for gastric sleeve surgery. A few of these include:
- A BMI that does not meet the minimum requirements
- An anticipated pregnancy within two years
- High operative risk (i.e. severe heart disease)
- Abnormal esophagus, stomach or intestine
- Severe Gastroesophageal Reflux Disease (GERD)
If you do not meet the requirements for gastric sleeve surgery, there are other weight loss options like the ORBERA® gastric balloon.
Requirements for gastric sleeve surgery: Insurance or private pay?
If you are considering gastric sleeve surgery, it is important to also consider your payment options and the requirements that come with them. While most insurance companies cover bariatric surgery, it can be a lengthy process collecting all of the necessary documentation and waiting for approval to be granted. Private pay allows you to avoid the waiting game, however surgery costs will have to come out of pocket.
With our 2019 gastric sleeve price of $8,999, our goal at BMI is to make losing weight a more attainable goal for our patients. Whether you choose to pursue private pay or insurance coverage, we will work with you to help you meet the requirements so you can lose weight and start feeling great.
CONTACT US TO LEARN MORE ABOUT GASTRIC SLEEVE REQUIREMENTS
Birmingham Minimally Invasive Surgery is a caring group of professionals who specialize in all types of bariatric surgery. Our surgeon Dr. Jay Long has highly specialized training in bariatric surgery, having completed a fellowship in minimally invasive and bariatric surgery at The Methodist Hospital in Houston, Texas, where he focused on taking care of patients that are morbidly obese. And we are so proud of our pricing that we publish the costs right on the front page of our website! Insurance won’t pay? We have a variety of financing options we can offer you so that you are able to get the healthy body you’ve wanted for years. Visit us today at www.bmisurgery.com or give us a call to set up a consultation at 205-833-6907.
