Surgery Approval Process

Preparing for bariatric surgery takes a number of steps over the course of six to 12 months. It’s important that you give your full participation to each step. These components will need to be completed for you to be ready for bariatric surgery.

Insurance Coverage

You or your parent will need to contact your health insurance carrier to determine coverage. Not all insurance covers weight loss surgery. Your insurance company may need detailed information from your doctor to approve surgery.

Letter of Medical Necessity From Your Family Doctor

As part of the process, you will need to request your pediatrician or family doctor to write a letter of medical necessity for bariatric surgery. The letter should be mailed to:

Center for Healthy Weight and Nutrition
Nationwide Children’s
700 Children’s Drive
Columbus, OH 43205

Or, can be faxed to (614) 722-3099.

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Bariatric Information Session

During the Bariatric Information Session, Dr. Marc Michalsky, the Center for Healthy Weight and Nutrition’s Surgical Director, will discuss the surgery options available and answer any questions you may have. After this session, if you feel surgery is right for you, an appointment will be made for you to meet the surgeon one-on-one.

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Psychological Evaluation

You will be scheduled for a psychological evaluation at Nationwide Children’s. The evaluation will take several hours. The psychologist will see if you have a good understanding of the surgery and if you have a strong support system. If you already have a therapist, our psychologist will work with them to make sure you have the appropriate care. We want you to be cared for before and long after your surgery. Our goal is to make sure you are ready for surgery and help you achieve the positive changes you want in your life.

Laboratory Work

You will have blood tests to check for any obesity-related medical problems. If any are found, a specialist will see you. Lab work is done every six months. We will also track vitamin and mineral levels before and after surgery to help us decide if you need any additional supplements. You will need to provide a stool sample to see if you are positive for Helicobacter pylori, which are bacteria that can cause ulcers. If you are positive for this, we will treat you with antibiotics before surgery.

Sleep Study

A sleep study is required to see if you have sleep apnea, which many overweight people do. The test is done in the Nationwide Children’s Sleep Lab and requires an overnight stay. If you have had a sleep study done somewhere else, please arrange to have those results sent to us, so we can determine if additional testing is needed.

Cardiology Evaluation

You will be evaluated by a cardiologist, who will check for heart problems. You will have tests to make sure your heart is healthy. One test is the electrocardiogram (EKG), which looks at the electrical activity of your heart. You will have an echocardiogram (ECHO) to look at the way your heart pumps. You will also be sent to The Ohio State University to have a cardiac MRI test to look at how the vessels around your heart function. Based on all tests, we will decide if you need special treatment during the time of your surgery.

Other Tests and Requirements

You will have a DEXA scan, which looks at your bone mineral density (BMD). Your BMD can change over time as a result of weight loss surgery, so we will check this yearly after your surgery, as well. An upper GI (UGI) X-ray will make sure there are no problems with your esophagus or stomach that would make the surgery difficult. There may also be other tests that your insurance requires for approval of bariatric surgery.

Bariatric Surgery Support Group

One requirement for the bariatric surgery program is that you attend at least two Bariatric Support Group meetings before surgery. We will be happy to help you with travel and accommodations, so that you are able to attend these very important sessions. They will help you learn more about the surgery and meet other people who have had bariatric surgery or are in the process of having surgery.

Approval for Surgery

Once all of the preoperative evaluations are completed, we will send the required paperwork to your insurance company for review. They then decide if they will approve the surgery. It is important for you to know that even if we feel you are a good candidate for bariatric surgery, your insurance carrier may not. Please know that even if your insurance company approves you for surgery, our team may feel that you need more time to be fully ready for surgery. Our office will contact you once we get a decision from the insurance company. If the surgery is denied, we may be able to appeal for a second review.