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The body weight criteria used by almost every insurance company is based off the National Institute of Health guidelines and recommendations for weight loss surgery. A patient is considered an appropriate candidate for weight loss surgery if :

Body Mass Index (BMI) is:
Between 35-39 with medical conditions that are related to excessive weight
BMI > 40
Calculate your BMI

Despite this, many insurance companies require that patients be able demonstrate that he or she has attempted less invasive methods to lose weight. This is usually through documentation in medical records. Some insurers require 6 months of documented weight loss attempts through their primary care physician. Other insurers have required up to 12 consecutive months. In addition, some insurerance providers require that the documentation be within a certain time frame (i.e. within the last two years). Most recently, some insurance companies have eased the requirements in patients who have extreme BMIs. Every insurance provider has its own guidelines regarding weight loss history and these guidelines are constantly changing.

Insurance providers may also require their customers to undergo specific medical, psychological and nutritional evaluations prior to approval. We recommend that every patient contact their insurance provider and find out what specific requirements must be met in order to receive pre-approval.

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