Bariatric Surgery Insurance Requirements Checklist

Pre-Qualification Checklist

BMI Documentation

• [ ] Current BMI documented by physician (BMI ≥ 40, or ≥ 35 with comorbidities)
• [ ] Weight history documenting chronic obesity (minimum 2-5 years depending on plan)
• [ ] Failed weight loss attempts documented

Supervised Weight Management Program

• [ ] Month 1 visit (weight, diet counseling, exercise plan)
• [ ] Month 2 visit (weight, progress assessment)
• [ ] Month 3 visit (weight, dietary modification)
• [ ] Month 4 visit (if 6-month program required)
• [ ] Month 5 visit (if 6-month program required)
• [ ] Month 6 visit (if 6-month program required)
• [ ] Each visit includes: weight, BMI, dietary counseling, exercise counseling

Required Evaluations

• [ ] Psychological evaluation by licensed psychologist/psychiatrist
• [ ] Sleep study (polysomnography) — OSA screening
• [ ] Cardiac clearance (EKG, possible stress test)
• [ ] Nutritional counseling (registered dietitian)
• [ ] Lab work (metabolic panel, lipid panel, HbA1c, thyroid, vitamins)
• [ ] Upper GI evaluation (some plans require EGD)

Comorbidity Documentation

• [ ] Type 2 diabetes (HbA1c, medication list)
• [ ] Hypertension (BP records, medication list)
• [ ] Obstructive sleep apnea (sleep study results)
• [ ] Joint disease/pain documentation
• [ ] GERD documentation
• [ ] Any other obesity-related conditions

Substance and Nicotine

• [ ] Nicotine screening negative (if required by plan — typically 3-6 months cessation)
• [ ] Substance abuse screening/clearance

Surgeon Requirements

• [ ] Bariatric surgeon is in-network
• [ ] Surgeon meets plan's credentialing requirements
• [ ] Facility holds bariatric center of excellence designation (if required)
• [ ] Surgeon's letter of medical necessity