Eligibility, Insurance & Billing Criteria
Am I eligible for WLS?
Patients must meet specific criteria, based on guidelines established by the National Institutes of Health, before they will be considered for an evaluation with our team. Most patients who enter our program have a BMI of 40 or greater. Other factors that suggest surgery may be a good option include:
- Be a minimum of 100 pounds overweight.
- Serious medical conditions related to weight, such as diabetes, sleep apnea or heart disease. (If these are present, surgery may be considered if the BMI is between 35 and 40.)
- Age between 18 and 65 years (with some exceptions)
- A long history of obesity, with many failed formal, structured and/or documented attempts at weight loss
- No current issues with drug or alcohol abuse
- No serious psychiatric illness, such as problems that would impair someone's ability to follow a program of lifetime health management and follow-up
Bariatric Surgery in many cases is covered by various insurance plans. Please contact your insurance company and ensure that Bariatric Surgery (Lap-Band) is covered under your plan and that you are able to have your procedure at Beth Israel Deaconess Hospital-Milton.
Depending on your health insurance provider or managed health care plan, you might need a pre-authorization or referral before seeing a physician or specialist. Contact your health insurance provider if you have questions about the specifics of your health care coverage.
If your health insurance provider requires a managed care referral, please contact your Primary Care Physician before your appointment and have them fax the necessary referral to us at (617) 298-0315.