Navigating the Path to Bariatric Surgery: Eligibility, Insurance, and Preparation – ARC Summit

In California, most insurance carriers cover bariatric surgery, although certain qualifications must be met. Candidates for surgery should have a Body Mass Index (BMI) of 35 or higher coupled with at least one weight-related health issue, such as diabetes, hypertension, high cholesterol, or sleep apnea. Alternatively, a BMI of 40 or higher is sufficient even without accompanying health conditions.

Potential candidates must be medically fit to undergo the stresses of surgery. Furthermore, many insurers require a six-month period of medically supervised weight loss before approving the procedure. This prerequisite, often viewed as a barrier to access, is intended to ensure patients are committed to long-term lifestyle changes that support the effectiveness of the surgery.

In addition to these physical health requirements, candidates must not have active alcohol or drug addiction issues. Mental stability and a comprehensive understanding of the surgical risks are also crucial. This comprehensive screening process helps ensure that only patients who are likely to benefit from and cope with the surgery and its aftermath are selected.