About Bariatric Surgery
All treatments for obesity, whether surgical or non-surgical, center around reducing your daily calorie intake.
The “machine” that is your body needs a certain amount of fuel (energy) each day to function. This daily requirement is called the Basal Metabolic Rate (or Basal Energy Expenditure), measured in calories, which are units of the energy content of food. Your body needs a certain number of calories each day just to function, to “run”.
Over time, if your body receives less fuel (food calories) than it needs each day, it will obtain the remaining required energy from the calories stored in the body as fat (and muscle). In other words, the reduction in your daily dietary calories after bariatric surgery will cause your body to consume stored fat to use for fuel. This fat consumption leads to weight loss. After bariatric surgery, unwanted muscle consumption is lessened by taking in sufficient dietary and supplemental protein.
Bariatric surgery limits your calorie intake, causing you to lose weight, until your body “re-calibrates” to a lower daily calorie requirement, a lower Basal Metabolic Rate. Thereafter, if you do not take in more calories than your body then requires at this lower weight, you will not regain weight.
“CAN I HAVE BARIATRIC SURGERY?”
YES. If your BMI is 40 or greater, or if your BMI is between 35 and 40 and you have comorbidities associated with obesity, you qualify medically for bariatric surgery and meet the weight requirements for insurance authorization.
If you have commercial health insurance, our staff will determine whether your specific policy covers bariatric surgery. Click Here for Free Insurance Check.
All insurance carriers (commercial insurance, such as Aetna, Blue Cross/ Blue Shield, Cigna, United Healthcare, etc; Medicare, and all AHCCCS plans) have their own specific requirements that must be met before they will authorize your bariatric surgery. Click Here to see the bariatric surgery prior-authorization requirements for you insurance company.
First, all insurance carriers require the following:
- Age 18 or older
- Primary Care Provider (PCP) Bariatric Referral Letter (Letter of Medical Necessity)
- A consultation with a Bariatric Surgeon
- A consultation with a Dietician or Nutritionist
- A consultation with a Psychologist
Second, you may also require:
- Medical Clearance(s): Cardiology, Pulmonary (lung specialist), etc.
- Other medical tests at the discretion of the bariatric surgeon
Finally, most commercial plans and all AHCCCS plans require a period of “Physician Supervised Weight Loss”. This typically involves a series of consecutive visits to your PCP (over a period of 2 to 6 months depending on your insurance), who documents your pre-operative weight loss plan at each visit, then forwards the information to our office. Medicare generally does not require this, but certain administered Medicare plans and Medicare supplement plans often do. Typically, you are not required to lose a certain amount of weight during this process in order to be approved for your surgery, but simply demonstrate that you have participated and completed this requirement.
STICK WITH IT. WE WILL HELP YOU REACH YOUR DREAM!
At the time of your initial visit, we will determine your specific medical and insurance requirements, help you schedule them, and guide you through the entire process with periodic updates. Remember, if you have met all the authorization requirements, your insurance company cannot deny you from having bariatric surgery. Once we have received the completed documents and reports, we will submit this information to your insurance company. When authorization is obtained, we will call you to schedule your surgery. Even if the process takes 6 months, you have suffered from obesity for far longer and don’t want to continue to suffer from it for far longer.
LET’S GET YOU READY
First of all, it is very important to us that you fully understand the steps leading up to surgery, what the experience of surgery and recovery will be like and how you can achieve the greatest success after your surgery and for the rest of your life. Therefore, we will be educating and guiding you through your entire journey. In addition, there is nothing more important to us than the safety of your surgery and recovery. Consequently, we will perform a thorough evaluation of your health before surgery to identify and address any issues that may affect your surgical risk.