Are you a candidate for weight loss surgery?
With over 6 million Americans suffering from morbid obesity, the need for weight loss surgery has become more apparent. Morbid obesity brings with it a plethora of health issues that if left untreated will substantially shorten life expectancy. In fact, morbidly obese adults (those individuals whose weight is twice the ideal amount) are twice as likely to have an early death as compared to a non-obese adult.
Would you like to know if you are a candidate for weight loss surgery? To determine if you are a candidate for surgery, it's important to know what medically classifies an individual as morbidly obese. The following criteria are characteristic of a morbidly obese individual and could qualify you for weight loss surgery:
- 100 pounds or more over their ideal body weight
- BMI (Body Mass Index) of over 40
- A BMI of 35-40 accompanied by significant life threatening medical conditions such as Type II diabetes, high blood pressure, heart disease, and severe sleep apnea
- Inability to maintain a healthy body weight for a sustained period of time after numerous attempts to achieve weight loss with diet, exercise, medication, hypnosis, therapy, or a combination of methods
- Overweight for at least 5 years with many failed attempts at losing the excess weight
Weight loss surgery is often the only option for an obese individual to improve their health. In fact for many patients, the risk of death from not having weight loss surgery is much greater than the potential risks associated with the procedure itself. It's important that you discuss all of your concerns with our bariatric team. Remember, we're in this with you, every step of the way.
Please Note: It's important to remember that weight loss surgery is not the answer for everyone who suffers from obesity. The operation is an elective procedure so it's imperative that you are well informed on the potential risks and benefits involved. Also, the surgery is not a guarantee to produce and maintain long term weight loss. It's only the beginning of a lifelong commitment to healthy living that is required if you are to succeed. Following the operation, you will begin the process of making important lifestyle and behavior changes in order to increase your chances of experiencing lasting weight loss and continued good health.
Does insurance cover weight loss surgery?
Having health insurance does not guarantee you will be covered for weight loss surgery. Since the cost of this procedure can be very expensive, most patients would not even consider it an option if it were not for insurance or low interest financing. Although weight loss surgery is still considered an elective procedure, it may be covered by your insurance carrier. For this reason, it's important that you fully understand what is and is not covered by your insurance provider.
Before you attempt to get authorization, here are some helpful hints to assist you with the authorization process:
- Read and understand your insurance provider's "certificate of coverage."
- Get a referral and copy of medical records from your primary care physician in order to substantiate your claim
- Keep accurate, detailed records of visits to healthcare providers. Also, save receipts for any exercise equipment, fitness programs, diet centers, weight loss drugs and anything else that can assist in the authorization process
With so many different insurance policies and types of plans among insurance providers, it's important that you understand the authorization requirements for your individual policy.
The insurance company will typically ask for the following information and documentation (Be prepared to provide these upon request):
- Current weight, height, and BMI
- Verification from a physician that the patient is 100 lbs or more over their ideal body weight
- The surgery recommended along with any post operative follow-up care, including nutritional and psychological support
- A detailed medical history including co-morbidities (i.e., the presence of one or more diseases in addition to a primary disease)
- Six (6) months of medical records including a patient evaluation, treatments performed to date, and specific types of lab work done
- Six (6) months of a documented dieting and exercise routine (must include dates and results)
- A psychological/psychiatric evaluation
Once you have submitted your claim it's a simple matter of waiting for your insurance provider to respond. At times it can be a frustrating and discouraging process, but don't give up. If your claim is denied you have the right to appeal the decision. Being denied coverage for surgery happens to many patients and this initial set back does not mean that you've reached the end of the road. Some insurance providers may initially deny bariatric surgery claims automatically the first time they're submitted, and can be more receptive to follow-up appeal letters.
If you have questions about the insurance process, please don't hesitate to contact our office. Let our experienced bariatric team help you with the authorization process.
Is bariatric surgery safe?
A surgical procedure of any kind will always involve a certain degree of risk, and bariatric surgery is no exception. In the past, weight loss surgery was viewed as extremely risky. However, with the development of new procedures and advancements in technology, bariatric surgery is a relatively safe solution to morbid obesity. Today, the overall risk of weight loss surgery is fairly low with most patients experiencing few, if any, complications. This is not to minimize the fact that this is still a serious operation, which should only be considered after all other weight loss options have been exhausted. Once a surgeon has determined that you are a candidate for weight loss surgery, it's very important that as a patient you reveal all pertinent medical information to your surgical team. The bariatric surgeon will assess the risks involved with your particular surgery and take every precaution necessary to ensure your safety and to reduce the risk of complications. Regardless of the type of weight loss surgery, it's important that the decision to undergo surgery is carefully thought out. It's imperative to weigh the risks of surgery with the long-term risks of remaining obese. Discuss any concerns you might have with your surgical team and your outside support system (family, friends).
What is morbid obesity?
Obesity results from having an abnormally high proportion of body fat which exceeds the body's skeletal and physical standards. Obesity develops into morbid obesity when an individual is 100 pounds or more over their ideal bodyweight and has a BMI (Body Mass Index) of 40 or higher. Morbid obesity affects an estimated 10 million Americans; a number that has nearly doubled in the last 30 years. Morbid obesity includes one or more serious health conditions or diseases that are a direct result of the excess weight an individual is carrying. These are known as co-morbidities. Co-morbidities result in an individual experiencing some type of significant physical ailment, which in some cases can lead to death. With over 10 million sufferers today, morbid obesity is becoming more than just a serious disease, it's a national epidemic. Let our bariatric team help you overcome your battle with obesity! Remember, you do have options. We want to see you succeed on your weight loss journey.
What kind of lifestyle changes will I have to make following surgery?
Aside from the most obvious change that takes place with respect to diet, there are a number of other lifestyle changes that have to occur in order to experience success on your weight loss journey.
- Avoid alcoholic beverages
- Avoid high fat, high fiber foods
- Chew slowly during meals
- Don’t drink with meals (it makes you feel full too fast)
- Keep snacking between meals to a minimum
- Omit desserts and sugary foods
Your post surgery physical activity level will likely be determined by the type of procedure you have undergone. Most patients can return to work within 1-3 weeks following laparoscopic surgery, while open surgical procedures may be slightly longer. Exercise can typically resume within six weeks or less after surgery.
Long term follow-up care will be required annually and sometimes more frequently depending on post-surgical body functions. There will be frequent testing to determine:
- Nutritional levels (vitamin B-12, iron, and folate levels, etc.)
- Is the patient anemic (i.e., low red blood cell count)
Having the support of family and friends is important; however, equally important is for a person to surround themselves with other weight loss surgery patients who understand the intricacies of weight loss surgery. Weight loss surgery is not a quick fix to repair the years of emotional pain caused by being morbidly obese. The support groups are merely a way for patients to share their challenges and/or success with others who have been through similar challenges. In fact, there is typically a big difference between the patients who are involved in a support group on a regular basis and those who attempt their weight loss journey alone. Our surgical team will provide you with a list of support groups to fit your needs.
For the first 18-24 months after weight loss surgery it's important that women of childbearing age do not conceive. Pregnancy can be taxing on the body and the potential for fetal damage increases. During this waiting period, it's important to give the body time to heal and recuperate. For this reason, a surgeon will typically advise you to take every precaution necessary to reduce the chances of becoming pregnant.