Qualifying for bariatric surgery is not always easy. Factors like age, BMI, commitment to a healthy lifestyle, comorbidities, and insurance play a role in determining if you’re eligible for this life-altering surgical treatment.
Here we will explore what can make you unfit for weight loss surgery and the steps you can take if you are denied.
Widespread Disqualification Factors
Patients won’t be eligible to undergo bariatric surgery when the risks outweigh the benefits. Most doctors will disqualify patients if they fit one or more of the following ten criteria:
- Age limitations – older than 70+
- Low body mass index (BMI) – less than 35 (U.S.) and 30 (Mexico)
- Low success rate for revision (gastric bypass revision or duodenal switch revision)
- Previous weight loss surgery – less than two years ago
- Pregnancy or plans for pregnancy
- Lung issues or severe asthma
- Heart problems (myocardial infarction or angina)
- Anemic – low glycosylated hemoglobin (HbA1c) level*
- High ASA (American Society of Anesthesiologists) score
- Testing positive for Covid-19
* lack of red blood cells or dysfunctional red blood cells
Note: Having any of the following does not completely disqualify you for weight loss surgery. All providers have different eligibility standards, and it’s always best to consult your Primary Health Physician.
What are my options if I don’t qualify for bariatric surgery?
In a study by National Bariatric Link, patients who were approved for bariatric surgery had a significantly lower prevalence of diseases associated with obesity than those who were denied; diabetes (0.3% vs. 9.2%), gastroesophageal reflux disease (0.6% vs. 19.4%), sleep apnea (0.4% vs. 34.2%), and hypertension (0.9% vs. 41.9%).
If you are denied weight loss surgery, there are options to help you become a qualifying candidate:
- Get an additional evaluation: Try filling out a health application with a different provider or see if you qualify directly from our surgeons at Mexico Bariatric Center. Click here to apply.
- Explore other weight loss options: Other weight loss methods include exercise, diets, endoscopic procedures, etc.
- Address your health problems: Individuals rejected due to health conditions can work with their healthcare provider to reduce their body mass through exercise or a nutrition plan.
- Switch to a different bariatric surgery: If you’re trying to qualify for a procedure like a gastric band, which is outdated and highly complicated, you may need to switch your surgery interest to the gastric sleeve (sleeve gastrectomy) or gastric bypass (roux-en-y).
- Changing your lifestyle: Joining support groups or fitness classes can help change your behavior that contributes to eating junk food or not being active.
- Look for surgery in Mexico: Weight loss surgery candidacy in Mexico has a lower BMI requirement.
These various alternatives can help you become healthier and happier with effort and determination. It’s important to talk to a medical professional to determine what suits your needs the best.
What are my options if I don’t qualify for insurance coverage?
If you are ineligible for insurance coverage, alternative methods exist to avoid being excluded.
- Address the individual eligibility requirements that you missed
- Travel outside the United States: Medical tourism is rising – you can save lots of money with Weight loss surgery in Mexico. Make sure the company you choose is safe and reputable.
- Out-of-pocket: If you don’t meet bariatric surgery requirements using medical coverage, you may be able to pay in cash through a nearby private bariatric provider.
- Financing or payment plan: If you don’t have payment up-front, there are low-interest payment plans available through banks, personal loans, and medical lenders. Do research to find the best payment option for you.
- Free Bariatric Surgery Programs: Social media is a great place to find sweepstakes and free bariatric surgery contests. Enter to win free weight loss surgery here.
- Join a webinar/seminar with discounted surgery.
It is your obligation to follow up with your insurance provider or primary care physician to do whatever is necessary to overcome obesity and get approved for bariatric surgery. One study by bidmc.org in 2020 found that “40 percent of individuals denied weight loss surgery in 2007 and never underwent the procedure were deceased by 2019.”
Our goal is to transform lives for the better through bariatric surgery, and we are eager to earn your trust. Contact us today to learn about our practice, schedule a consultation, and take the first step toward a brighter future.