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WSUPG Bariatrics uses the following criteria to determine whether or not you qualify for the lap band procedure:

  1. Age greater than 18 years
  2. BMI greater than 35 (usually 50 or more pounds overweight)
  3. Well motivated and well informed about the significant lifestyle changes necessary
  4. No active substance abuse problems within the last year
  5. Are medically healthy enough to tolerate the procedure

Unfortunately, most insurance companies use a different set of criteria to determine whether or not they will authorize the procedure. Each insurance company is different, but most agree on the following criteria.

  • Body Mass Index (BMI) of over 40, or
  • BMI of over 35 and have one or more of the comorbidities associated with increased weight.
  • Most insurance companies expect the patient to provide written evidence that they are unable to achieve a healthy body weight for a sustained period of time through medically supervised dieting, usually in the form of a medically supervised period of diet.

If you qualify for the procedure, but do not meet the demands based on your insurance carrier, you must elect the self payment option.

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