Getting Started

How to get started

Our program offers two paths — medical weight loss and surgical weight loss — and the steps to get started are different for each. Medical weight loss usually begins with a single consultation. Surgical weight loss follows a more structured process that includes a candidacy screening, an online information session, a full evaluation and insurance approval. Review the path that fits your goals below, or contact us and we’ll help you find the best starting point.

Medical Weight Loss

Medical weight loss is an option for patients who want to manage their weight with provider support — including nutrition counseling, behavioral support and prescription weight loss medications (such as GLP-1 medications) when medically appropriate — without surgery. Getting started is simpler than the surgical process. Contact us to schedule an initial consultation.

Your first visit is a one-on-one consultation with one of our providers, who will:

  • Review your medical history, current medications and weight history.
  • Complete an initial history and physical, and order baseline lab work if needed.
  • Talk through your goals and build a personalized plan, with regular follow-up visits to track your progress and adjust your plan over time.

The surgical candidacy criteria, seminar and evaluation steps below are not required to begin medical weight loss. If surgery becomes the right option for you later, your care team can help you transition.

Surgical Weight Loss

How Do I Know if I Am a Candidate For Surgery?

At Cumberland Bariatric Institute, weight loss surgery is done only if a patient meets the following criteria:

  • A Body Mass Index (BMI) of 35 or more. BMI is a simple way to calculate the amount of fat on your body. 
  • The person has already tried non-surgical weight loss treatments such as diet, exercise, and behavioral changes.
  • The person has no medical or hormonal reason for the obesity. These conditions are rare but require treatment of the underlying medical problem.
  • The person must be fully informed about the surgery and have realistic expectations of weight loss and possible complications.
  • The person must demonstrate a willingness to accept the risks of surgery.
  • The person must demonstrate a willingness to make dramatic lifelong changes in lifestyle, dietary habits, and exercise and also commit to medical follow-up.

BMI Calculator

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BMI

Appointment Scheduling

Once insurance review is complete a member of our staff will contact you to set up an appointment for an evaluation. When you attend a seminar at our facility, you will have the opportunity to speak with any number of our bariatric staff, including the surgeon, dietitian, nurses and insurance coordinator(s).

Evaluation

The evaluation appointment is scheduled for about two weeks after we call you. It’s a group meeting with a nurse, dietitian, surgeon and insurance specialist. You’ll also have a one-on-one meeting with the physician assistant for an initial history and physical. After that visit, you will be scheduled for:

  • A nutrition assessment.
  • A psychological evaluation.
  • A weight management program (if your health insurance requires this).
  • Additional medical tests, as determined by the surgeon.
  • You will need to attend a support group. People who have undergone bariatric surgery find it easier to make the necessary lifestyle adjustments when they have the opportunity to meet and talk with other people going through the same experience.
  • Your medical record will be reviewed. After all your tests are completed you will learn whether the clinic’s surgeon/physician assistant has cleared you for surgery.
  • Your case is sent to your insurance carrier for approval.
  • After the insurance company approves the surgery, your pre-operative appointments and surgery will be scheduled.

Insurance & Financing

Medical weight loss: Coverage for medical weight loss varies from plan to plan, and benefits for weight loss medications such as GLP-1s differ widely by policy and are changing quickly. Our team can help you understand your specific benefits before you begin.

Surgical weight loss: By using the Insurance Review Form in the Patient Profile Packet, you will know if your policy has benefits for weight loss surgery. If it does and you want to proceed, send in your Patient Profile Packet and the Insurance Review Form. We will screen your health history to make sure you are an appropriate candidate and our Insurance Team will make sure you meet the criteria set forth by your insurance policy. Assuming you meet all criteria, we will call to schedule your first appointment, where you will receive a personalized benefits form that will estimate, to the best of our abilities, your total out-of-pocket expenses. You will also need to complete a seminar, either in-person at our facility, or online.

Surgical Weight Loss Insurance FAQs

Most insurance plans require that your BMI be 35 or higher. However, if your BMI is between 30 – 35, many insurance providers will also accept/cover services if you have a life-threatening medical condition, such as high blood pressure, diabetes or sleep apnea.

How do I find out if my insurance covers weight loss surgery?

For commercial insurance policies, contact the customer service number on the back of your insurance card and ask this question exactly: “In my certificate of coverage are there benefits for weight loss surgery for morbid obesity if medically necessary?”

For Medicare and Medicaid, there are benefits for weight loss surgery as long as the criteria is met. There is no need to contact Medicare and Medicaid.

What does the insurance-required diet involve, and how long is it?

Usually the diet must be for at least 6 full months, which is one initial visit and 6 follow-up visits. Your appointments must be consecutive and the diet must be successful, meaning your end weight must be the same or less than your start weight.

If I have co-morbid conditions, do I still have to do the diet?

Most insurance companies that require a diet still require the diet no matter how many co-morbid diagnoses you have.

If my doctor writes a letter of support, do I still have to do the diet?

Yes, the diet is part of criteria set by your insurance company. Your physician can write you a letter of support which will assist in obtaining approval, but you still have to complete the diet.

My co-worker/friend started the same time I did. Why are they moving through the process faster than me?

This is a question that is asked a lot. Sometimes additional testing is required, one primary care may get the documentation back faster, or if your friend has a different insurance than you, maybe you were required to do a diet and your friend was not. If the insurances are different, then it may be because one insurance just takes longer to process than the other.

What if my insurance says there is an exclusion in my policy?

This means that your particular plan does not have benefits for weight loss surgery, no matter if you meet the medical necessity requirements or not. Your insurance may tell you that you have appeal rights. Keep in mind that you will be appealing policy and not medical necessity. If there are no benefits for weight loss surgery, it basically means that the benefit was not purchased by your company.

If my insurance will not pay for the surgery, can I pay for the surgery myself?

We do offer bariatric surgery for patients who would like to pay out-of-pocket. Please contact us directly for a quote.

My insurance question wasn't addressed here. Who can I contact?
Please send an email to our coordinator at Myra.Frye@LPNT.net.

Medical Weight Loss Insurance FAQs

Does insurance cover weight loss medications like GLP-1s?

Coverage varies by plan and is changing quickly. Our team will verify your benefits before prescribing, and we'll talk through your options if a medication isn't covered.

How long does medical weight loss take?

There's no set length — medical weight loss is an ongoing, individualized program, and your provider will adjust your plan based on your progress. (Note: The 6-month diet referenced in the surgical FAQs is an insurance prerequisite for surgery, not a medical weight loss rule).

Can I start with medical weight loss and consider surgery later?

Yes. Many patients begin with medical weight loss, and your care team can help you transition to the surgical process if that becomes the right choice.

Ready to Get Started?

Taking the first step does not mean committing to surgery — it means getting answers. During your first visit, we review typical insurance requirements and the steps needed before certain treatments, such as surgery. Whether you are interested in medical weight loss, bariatric surgery or simply want to understand your options, we’re here to help.

Not sure which approach is right for you? Start with a conversation. We can review your health history, explain your choices and outline possible next steps.

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