Who qualifies for gastric sleeve?

In order for a patient to qualify for gastric sleeve surgery, he or she must have been obese for at least 3 years, with a body mass index of 40 or more, and other morbidity related medical conditions.

Gastric sleeve is a surgical weight loss method. Although efficient and recently even covered by insurance, the procedure is not recommended for everyone. In order for a patient to qualify for gastric sleeve surgery, he or she must meet various criteria, including:

  • To have been obese for at least 3 years
  • To have a body mass index of 40 or more
  • To have a body mass index of 35 and other morbidity related medical conditions
  • To be between the ages 18 and 60
  • To have unsuccessfully tried other weight loss methods
  • To be aware of the potential risks and side effects
  • To be willing to make lifestyle changes

The body mass index is a method of measuring the level of obesity based on the height and weight of a person. Both surgeons and insurance companies will consider BMI when establishing whether a person is a good candidate for the procedure or whether the surgery will be covered by insurance. Usually men with at least 100 pounds overweight and women with at least 80 pounds overweight qualify for the procedure. Individuals with a lower body mass index can also be eligible if they suffer from any of the following medical conditions:

  • Diabetes
  • Heart disease
  • Sleep apnea

On the other hand, the procedure is not recommended for patients who have a history of alcohol or drug abuse or who present other medical conditions that increase the risks associated with a surgery.

Even if a patient meets the criteria for gastric sleeve surgery, there is still an issue regarding the costs of the procedure and the available financing options. The average cost of the procedure ranges from $9,500 to $22,000 in the United States, depending on the person’s general health, the geographical location where the surgery is performed, the type of the facility and the experience of the surgeon. This price often does not include hospital fees, medication, and anesthesia. However, these are cash pay prices, and are still considerably less than the hospital will charge or insurance company if you decide to use your insurance.

Since 2010 three of the major insurance companies decided to cover gastric sleeve surgery as a primary weight loss procedure. Since then many other companies also cover the costs of the surgery. 

Disclaimer: We do not assume responsibility for the use of the provided information or its interpretation. Our efforts are towards providing current and reliable information; however these should not be considered, or used as a substitute for diagnosis or treatment.

Source: https://www.cedars-sinai.edu/Education/Medical-Library/

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