CALL US: 352-265-0535

Surgery Criteria

Doctor with checklist

Weight-loss surgery candidates must meet the following criteria for surgery:

  • Have a body mass index of 40 or more OR
  • Have a body mass index greater than 35 with significant medical problems
  • At least 12 years or older (will be determined on an individual basis)

Referral Criteria

If you meet the criteria above for surgery and have taken our in-person or online seminar, you are ready to make a clinic appointment. Before doing so, please consider insurance coverage and payment options.

  • You may or may not be covered by insurance depending on your provider and/or health plan.
  • In order to provide coverage, some insurance providers may require that you have a referral from your primary care physician. Some may also require proof of at least 6 months of weight loss effort. Please call Tina Adams at 352.265.0535.
  • Some plans will allow you to self refer; which means you can make an appointment with us directly, without a referral.
  • If you have Medicaid, you will need a referral, please see requirements below.

Insurance coverage with bariatric surgery can be challenging, which is why we have a dedicated insurance specialist to assist you with pre-operative mandates required by individual insurance plans. If you have specific questions or would like to talk to our specialist, please call 352.265.0535.

Talking to Your Insurance Provider

If you would like to talk to your insurance provider prior to taking a seminar and scheduling a clinic appointment, here are a few tips.

First, ask your insurance provider if bariatric surgery is covered under your policy. If it is covered, check that the operative procedure you are considering also is covered. You will need to supply these CPT codes:

  • For the Roux-en-Y procedure, give them the CPT Code of 43644.
  • For the Lap-Band procedure, give them the CPT Code of 43770 (many insurance companies do not approve the Lap-Band procedure, so check thoroughly with your insurance company).
  • For the sleeve gastrectomy procedure, give them the CPT Code of 43775.

Finally, ask if UF Health Shands Hospital is an approved facility under your insurance provider. We use the tax I.D. of 591943502. Giving this number to your insurance company may facilitate a faster response to your query.

Other Payment Options

If your policy does not cover the diagnosis of morbid obesity or the operative procedure itself, you still have a few options:

  • You could obtain another insurance carrier, but you need to be sure the new policy covers bariatric surgery before making this decision.
  • You may continue to participate in alternate medical programs designed to lose and maintain weight loss.
  • In selected cases, we will consider performing the surgery if you elect to self-pay. The hospital requires a considerable deposit, and you must fully understand all risks of the financial burden. We will review this major decision with you extensively and will help in any way we can. 

If you are interested in self-pay options for bariatric surgery, call Damaris Benton at 352.265.0111, ext. 44702 to make arrangements. Full payment must be received 10 days prior to surgery. 

Following are the costs for each type of surgery:

  • Lap gastric banding (includes five fills): $15,348
  • Gastric bypass: $18,348
  • Sleeve gastrectomy: $16,348

The estimates listed above cover the cost of physician, anesthesia and facility fees for the procedure only. These costs do not cover fees associated with a consultation, pre-operative appointments, testing, nutritional counseling, protein supplements, vitamins or any additional services while inpatient. 

Please note that certain insurance companies require supervised weight loss. You can download our supervised weight loss form (PDF) here.

Medicaid Requirements

To qualify for Medicaid coverage of bariatric surgery, patients must meet the following criteria:

Presence of Morbid Obesity:

  • 100 pounds overweight
  • Body Mass Index (BMI) greater than or equal to 35 with co-morbid conditions (cardiopulmonary problems, obesity related cardiomyopathy, severe diabetes mellitus, hypertension, sleep apnea, or arthritis)
  • Or BMI of 40 without comorbidity
  • There is no treatable metabolic cause for the obesity, such as adrenal or thyroid disorders
  • The patient is an adult (at least 18 years of age)

Before we can schedule any appointments, we must have a referral from a primary care provider and the information listed below.

  • Letter of medical necessity from PCP for a referral to a bariatric surgeon
  • Medical records documenting diagnoses and appropriate treatments of co-morbid conditions
  • Current weight and height
  • Plans for participation in a postoperative multidisciplinary program that includes guidance on diet, physical activity, behavior management and social support
  • History of participation in a three-month, physician supervised multidisciplinary weight loss program within the past six months that included:
    • Dietary therapy
    • Physical activity (moderate levels of activity for 30 – 45 min., 3-5 x/wk)
    • Behavior-management support

If you have completed an online or in-person educational seminar and would like to make an appointment, you may view and complete our new patient forms.

Download a copy of our informational brochure:

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