Dr. Feiz and Associates Answer September’s ‘Patient Submitted Question of the Month’: “What do Insurance Companies Look for in Bariatric Candidates”

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Dr. Feiz has selected this as the medical office’s September ‘Question of the Month’ in response to recent patient questions about insurance coverage for those seeking out weight loss surgery.

The most clear-cut factor that determines whether or not a person is eligible for weight loss surgery is each individual patient’s BMI (body mass index).

Dr. Feiz notes that [insurance companies'] decision [of whether or not to provide coverage] factors in many variables other than the question of whether or not it would be good for a patient’s health.

As weight loss surgery becomes more and more popular, bariatric surgeon Michael Feiz, M.D., F.A.C.S. says that he has been fielding an increasingly high number of questions from patients who want information in regards to when insurance companies do or do not provide coverage for weight loss surgery. While a number of studies have shown that bariatric surgery can have incredibly positive long-term results for severely obese patients, the procedure, like nearly every surgery in the 21st century, costs insurance companies a great deal of money. Dr. Feiz explains that this leads insurance companies to scrutinize applications for weight loss surgery coverage, and they often only accept candidates for whom they determine surgery is a worthwhile investment in terms of future savings they might otherwise have to spend on elaborate treatments. While patients who do not receive coverage often disagree with the insurance company’s assessment of their need for surgery, Dr. Feiz notes that their decision factors in many variables other than the question of whether or not it would be good for a patient’s health. According to Dr. Feiz, some of these variables include:

  • BMI – The most clear-cut factor that determines whether or not a person is eligible for weight loss surgery is each individual patient’s BMI (body mass index). Dr. Feiz explains that a person is typically eligible for weight loss surgery coverage if their BMI is at 40 or above, or 35 and above in combination with one of the health problems (comorbidities) associated with obesity.
  • Comorbidities – While many people are aware that, behind smoking, obesity is the second leading cause of premature death, it is actually co-morbidities resulting from obesity, such as diabetes and heart disease, which actually threaten a patient’s life and cost insurance a great deal in terms of patient care. Dr. Feiz notes that it is for this reason that having one of these conditions allows for a slightly lower threshold when it comes to a patient’s eligibility in relation to their BMI.
  • Ability to Commit – In addition to the factors that relate to a patient’s physical health, insurance companies providing coverage for weight loss surgery also require that a patient undergo a basic psychological evaluation to make sure that they are the type of person who can make the behavioral modification necessary to successfully lose weight. Dr. Feiz always reminds his patients that weight loss surgery is by no means a silver bullet to defeat obesity, and that it still requires a great deal of commitment on the part of the patient to find success.

Dr. Feiz wants to make sure that patients are aware that, even when their insurance isn’t willing to cover the procedure, financing opportunities are available to allow patients access to the care they need. Any patients interested in learning more about weight loss surgery can call Dr. Feiz & Associates today at 310-855-8058 or visit them online at http://www.DrFeiz.com.

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Michael Clauw
Cyberset Corp
+1 (818) 883-7277 Ext: 121
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Dr. Michael Feiz - Sleeve & Lapband Surgeon
since: 09/2010
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