Weight Loss Coverage
With the rate of obesity going up everywhere, the need to take more aggressive approaches has become more necessary than ever. A lot of health plans actually have weight loss coverage in their policies. In fact, some states require that insurance companies offer that option. But, the person needing surgery, physical therapy and/or medicinal abet has to meet clear criteria set forth by the National Institute of Health (NIH) before coverage can kick in.
Requirements for Meeting Weight Loss Coverage Criteria
Virtually no insurance thought will hide a diet, diet food or maybe even diet pills but you can pick up them to cover procedures like bariatric surgery and the LAP band. The average cost for bariatric surgery is about $20,000 and that doesn’t include the follow up care and doctor’s visits. Most insurance companies rely on NIH guidelines to create a list of requirements that you have to follow in order to qualify for coverage.
Are you Obese?
First of all you or your doctor need to calculate your absorb BMI percentage, and you can do this by multiplying your height in inches by you height in inches (your height in inches squared). Then you select you weight in pounds and divide it by your height in inches squared and once you multiply the whole thing by 703, you should end up with a percentage. If it is over 40%, you are considered morbidly obese and anything over 50% is considered trim obese and the first main component for insurance coverage is exhibit. If you happen to topple between 35% and 40%, the only way to be considered by your insurance company for covering your weight loss procedures is if you also have serious health risks like heart disease, diabetes, circulatory problems, and breathing problems related to your weight.
More Requirements and Weight Loss Methods that you Have to Try First
Your insurance provider will more than likely need you to (and the NIH recommends) that you try other methods of weight loss before going a more drastic route. You will also have to prove that you tried with the proper documentation. You will probably be asked to capture part in a medically monitored weight loss program that consists of diet, exercise, and medication. You may also be asked to take a psychiatric examination to see if you are ready to follow the strict lifestyle required after surgery.
Do you qualify for Weight Loss Surgery?
If you are looking for a little bit of liposuction or other cosmetic procedure to help you lose weight, you will have to pay for that on your own. If you meet the criteria listed above you may be able to get your health insurance to veil your weight loss surgery. Surgery is basically the last step if nothing else works. So long as you can document that to your insurance, they should authorize it. If not, you can see about an appeal.
Bottom Line for Weight Loss Coverage
If you want your weight loss procedures covered, you have to follow the guidelines outlined in your insurance policy, so read it carefully or you will have to pay for it all on your beget. If you follow the guidelines, you may be able to get your weight loss medications, physical therapy and surgery (if you and your doctor decide that surgery is the best approach for your individual case) covered and paid for by your insurance company.
References:
Weight Loss Surgery Insurance – http://www.wlshelp.com/weight-loss-surgery-insurance.html
Obesity and Weight Loss Coverage – http://www.medicare.com/services-and-procedures/obesity-and-weight-loss-coverage.html
What does Medicare Part A Cover? – http://questions.medicare.gov
CLINICAL GUIDELINES ON THE IDENTIFICATION, EVALUATION, AND TREATMENT OF OVERWEIGHT AND OBESITY IN ADULTS – http://www.nhlbi.nih.gov/guidelines/obesity/ob_gdlns.pdf
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Filed under Bariatric Surgery by on Mar 14th, 2011. 
If you have gotten to the point where you have weight loss surgery scheduled, you’ve been alive to in the process for some weeks or months and you’ve made a firm decision to surgically deal with morbid obesity. You may still have nagging doubts and fear of the unknown, but you have decided the risks of weight loss surgery outweigh the risks of remaining dangerously overweight. How do you prepare for weight loss surgery itself?
Getting Your Affairs in Order
Depending on the weight loss surgery you have, you’ll be physically out of commission from 2 to 6 weeks. Net with your benefits department at work to hold out vital paperwork and fabricate arrangements to have your job duties covered. At home, catch up on household chores and stock up on basic items. It’s hard to say what you’ll want to – or be able to – eat when you get home. Have soft foods, various drinks and a few protein items like drinks and bars ready. Don’t get too much of any one thing in case it doesn’t agree with you later. Go ahead and buy your doctor-recommended supplements now. Fill your prescriptions if the surgeon has given them to you ahead of time. Prepare any vital paperwork like power of attorney or special medical documents. Some people do like to be sure their will is in order and leave pertinent information about household bills and affairs with a family member. This is a wise precaution to take before any surgical procedure, not just weight loss surgery.
Pre-Surgery Medical Testing
Often, a day is set aside for you to go to the hospital and accumulate all your pre-weight loss surgery testing and blood work done. This happens fairly halt to the surgery date and you will be directed through the process. In addition to the testing, there may be a tour of the hospital area where you will halt after surgery and a class covering weight loss surgery and recovery procedures.
Thinking Ahead About the Hospital Stay
Hospitals, like many institutions, have overworked and underpaid staff. Certainly the care will be adequate, but if you do a little planning, you can execute your hospital experience after weight loss surgery a bit easier. First, check on the cost of a private room. This is not covered by insurance, but can be as tiny as $40 per night. The privacy and lack of a potentially annoying room mate will more than justify the expense. Additionally, you might want to consider having someone stay with you the first night. That is when you are most vulnerable and unable to speak for yourself should a spot arise as a result of your weight loss surgery. A friend or family member can be very helpful in seeing to your comfort and seeking assistance if it is needed.
What to occupy to the Hospital
Really, you need very exiguous. Notion to wear something loose fitting that you can also wear home. Weight loss surgery involves an abdominal incision and you won’t want anything tight across it. The hospital provides a gown, slipper socks and toiletries, so take advantage of that unless you have special needs. Pack a small tote with your hairbrush, eyeglasses, chapstick and a couple magazines. Women might throw in some earrings and a lipstick if you contemplate you want to get spiffy in a day or two. Otherwise, plan to rest and let the nursing staff take care of you. Keep it as simple as you can.
Considerations for Returning Home
You’ll be glad to gather out of the hospital and the trip home will probably make you ready for a nap. With the incision from the weight loss surgery, you might not want to face the bed just yet, so be prepared to stretch out in the recliner. A neck pillow is handy for comfort and you might even determine to sleep in the recliner at first since it gives you a boost up. Now is when you might like to effect on some new jammies or a nice robe for company, so have those at the ready if you think you’ll want them. If you are having an commence weight loss surgery that requires wearing a binder, purchase a package of men’s sleeveless t-shirts to wear between you and the binder. The shirts are very thin and comfortable, come in packs of three, and are inexpensive enough to discard once you are recovered.
You’ve made your decision and scheduled weight loss surgery. Prepare the best that you can and keep a positive attitude. Weight loss surgery is about to change your life.
sources
Heather Hatfield, “Preparing for Weight Loss Surgery”, WebMD
JAMA Patient Page, “Bariatric Surgery”, The Journal of the American Medical Association
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Filed under Bariatric Surgery by on Feb 18th, 2011.
With obesity on the rise today, many are looking at surgery as a snappy means to lose weight and to prefer care of health problems related to being overweight. Gastric bypass surgery, also known as bariatric surgery, is a drastic surgery done to help befriend obese people in weight loss. Since unusual technologies for this surgery has been developed, making it less painful, and cutting healing time in half, this surgery has increased in popularity. Surgery increases were 450% between 1998 and 2002, going from 12,775 to 70,256. In 2004 the number of surgeries were estimated to be about 171,200.
Gastric bypass surgery is done laproscopically, in most cases. The physician creates a petite pouch at the top of the stomach and adds a bypass around a segment of your small intestines. Your stomach is then stabled across the top, sealing it off from the rest of your stomach. The end result of the new stomach pouch is about that size of a walnut and can hold about an ounce of food.
This surgery is not for everyone, nor does everyone seeking this drastic surgery qualify. It is only for the extremely obese. There are certain criteria that a person must meet in order to get the gastric bypass surgery done. Some of the criteria for surgery are: 1. You must have a body mass index of 40. 2. You must have a body index of 30 or higher. 3. You must be 90 lbs overweight or more. 4. You have been obese for at least 5 years. 5. You have tried all other methods to lose weight.
There are advantages to having this surgery, the most obvious is losing weight and feeling healthy. Before many have the surgery they are usually plagued with a number of health issues from high blood pressure to diabetes. Many are on several medications to control these illnesses. After surgery many see a major improvement with their health problems. 80% of patients, within 2-3 months after surgery, will manufacture normal cholesterol levels and lower blood pressures. 90% of patients, who had type-two diabetes, will obtain excellent results within a few days after surgery. Some patients will even become medication free.
There are health risks as well when having gastric bypass surgery. Lung problems can occur by lack of motion of the chest wall. Deep breathing and lung exercises can prevent this. Another risk would be leakage of bowel connections. This happens when the connection of the bowel to the original stomach does not form a complete seal. This can become a serious complication. Everyone takes a risk, but the outcome to be thinner and healthier outweighs the risk for most people.
I was able to interview Jennifer who under went gastric bypass surgery about a year ago and here is what she said:
Dawn: Have you always had weight problems?
Jennifer: I have been overweight since I was 7 years old. Got worse when I hit puberty and kept getting worse!
Dawn: What diets/pills have you tried? Did they ever work?
Jennifer: I was on Weight Watchers when I was in junior high and did ok on that. I also took phen/fen and lost weight with that but then it was pulled because of causing heart problems and I ended up with some problems from taking that. I also would go on Atkin’s Diet and would lose some, but not much.
Dawn: Did you have any medical problems before surgery that were directly related to weight?
Jennifer: Polycystic Ovarian Syndrome, Sleep Apnea, Hypertension, Edema in my feet and ankles, Infertility, Insufficient Aortic Valve, Mitral Valve Prolapse.
Dawn: How did you learn of gastric bypass surgery?
Jennifer: From the news on TV at first, then researched it on the Internet.
Dawn: Did you research the pros and cons of gastric by-pass?
Jennifer: I researched it on the Internet, through other people that had had it…I read a lot of online journals and joined some online support groups, and then did more research through my doctor.
Dawn: What finally lead you to the decision to get the surgery done?
Jennifer: It was getting harder and harder to maintain up with 2nd graders and I wasn’t as good of a teacher as I had been…didn’t have enough energy and my feet and ankles would swell everyday. I also want to have a baby and knew that I couldn’t accept pregnant at that weight and wouldn’t be able to care for a baby at that weight…no energy.
Dawn: What emotions were you feeling the day of surgery?
Jennifer: I was very scared…it was my first surgery ever…never had a broken bone, stitches, or been in the hospital before, but I was a woman on a mission. When I look back on it, I was given strength by God, that is the only scheme I can explain it because I don’t see how I went through with it if God wasn’t there making it happen…if that makes sense.
Dawn: After your surgery did you have any complications? How long did it grasp you to heal?
Jennifer: After my surgery the worst thing that happened was a horrible period that lasted about a week…super painful…worst cramps ever, but since then, my periods have become less painful and a lot lighter and shorter. I haven’t really had any side effects. I can’t take aspirin, steroids, or anti inflammatories anymore so that is hard because I can’t take Advil when I was used to taking a lot of that. Those meds can cause stomach ulcers, which is why post ops can’t choose those meds. It took about 7 days for my stomach to stop feeling tender. I still have scars where my incisions were, but no pain at all. I have to take vitamin supplements daily to help me with nutrition.
Dawn: What foods can you eat and not eat?
Jennifer: I have a hard time with bread because it is so soft. I also can’t eat a lot of sweets and ice cream makes me sick. Pecan pie on Thanksgiving made me extremely ill. Carbonated drinks design me feel yucky. I can drink sweet tea ok, but usually drink water. I had trouble with chicken for a while but now can eat that. I do well with soups, moist meat, fruit, vegetables, crackers, chips, beef, and seafood. I haven’t found anything that I can’t have just a small amount of it. I have done really well since the surgery.
Dawn: What was your starting weight before surgery?
Jennifer: 313 lbs
Dawn: How much weight have you lost?
Jennifer: 100 pounds
Dawn: What is your goal weight?
Jennifer: 150-ish
Dawn: Would you recommend this surgery to others?
Jennifer: YES! And I would recommend my doctor…Dr. JK Champion at the Videoscopic Institute of Atlanta. He does surgery at Emory Dunwoody Hospital.
Dawn: If you had to do it again, would you?
Jennifer: In a heartbeat!
If you are thinking of getting gastric bypass surgery, understand the pros and cons of having it done. Research and weigh the risks. Talk to others who have had it done as well as a bariatric surgeon. In the end it’s up to the individual and what is going to make them happy and healthy.
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Filed under Bariatric Surgery by on Feb 16th, 2011.
In May of 2000, I was one of the many people in the United States to obtain something called a Roux-En-Y Gastric bypass. You hear scare stories and success stories when people talk about getting weight loss surgery done, so I would like to share my own experience that is completely honest about pro’s and con’s.
A person who says that getting a gastric bypass is the easy way, doesn’t have a clue what they are talking about. This surgery is life changing on a fundamental level, emotionally as well as physically. I have lost over 200lbs, and gained what I feel is wisdom. Hind sight can be more than 20/20 if you look closely.
If your surgeon is good, they will ask you to keep a food diary for three to six months before the operation so they can be certain it’s a required surgery and not something that can be taken care of with diet and nutrition counseling.
They will send you to nutrition classes to teach you how to rethink what you eat, looking for the hidden problems with the foods you’ve been writing in your journal even though you’ll be getting the procedure. The reason they do this, is so you can make sure you have superior eating habits after your recovery.
I personally was not allowed to eat anything 24 hours prior, or drink anything 12 hours prior to mine being done. However, surgeons may differ on what they ask you to do or not to do.
After the surgery, I woke in recovery with little to no problems. I had an umbilical hernia repaired at the same time that was rather severe so my incision was roughly a foot long. When they released me, I still didn’t feel much of the wound because I was on something called Roxicet in liquid form. I was able to lift that medication for about a week, after it was gone the pain was intense.
Depending on who your doctor is and what your personal situation may be, determines how well the operation goes for you. One thing you must remember though is no matter what the personal complication is, the surgery all by itself is a serious operation that is most times irreversible. This is not something to be entered into lightly. Some have come out with little to no pain whatsoever, others have ended up dying. You and your doctor must be positive this is the right choice for you. Most people who undergo this surgery do it using laparoscopy, others have it as I did with open surgery.
Recovery from my surgery took more than four months, it was much longer before I could have tubby movement in my abdomen without discomfort. During that time I was exhilarated, the weight was pouring off.
This is where honesty comes in, a Roux-En-Y changes the way you’re hooked up inside. It takes your intestines and hooks them to the top of your stomach where a small pouch is made from the tissue. The rest of your stomach is then disconnected and re-hooked to your intestines in another place allowing the fluids it produces to flow into the intestines.
The result is you are left with an egg sized pouch to acquire the food, and you digest in your intestines. Therefore “bypassing” the stomach altogether. The stomach is left free floating in your abdomen.
Because your body isn’t gripping the food, it starves. Some people, like myself, have difficulty digesting anything for the first year. I survived off of baby food, soft scrambled eggs, yogurt and drinking fluids.
There are things I can’t eat to this day. Steak is a thing of the past, and something I enjoyed. I can have nothing with carbonation in it which includes soda, beer, champagne or even pop rocks. Anything with a high amount of sugar in it gives me something called “Dumping Syndrome” because the sugar goes right into your intestines making you very sick and shaky.
Alcohol has become something I drink only on rare occasions. I absorb it rapidly through my intestinal wall, and become very drunk in a short amount of time followed by stomach pain and nausea.
Fortunately for me, I can still drink coffee which is something I don’t think I could live without. Some people however can’t drink it afterwards because of it being acidic, it tears up the lining of their gastric tract. It’s for that reason I can’t drink citrus juices.
My hair fell out in clumps from malnutrition and I developed two forms of deficiency, one from iron and the other from being unable to absorb B complexes.
My skin started to sag, in the first ten months I lost over 150lbs. I was dry and flaking, my teeth became loose and my self esteem hit an all time low.
I started having fainting spells, and was exhausted all the time. I ended up getting blood tests and had to take shots every week to get my imbalances under control. I was informed that permanent damage could happen if it kept on for an extended period of time.
I was willing to deal with all of the negatives because I could play with my children again, be intimate with my husband and purchase clothes without people staring. I was finally unnoticeable, no one whispering when I went to the store to buy groceries. I could go to a movie and sit in a regular seat instead of one for the disabled. Going to the beach was no longer a humiliation for me, shorts stopped being a nightmare.
I could go camping, and only have to use one sleeping bag instead of having to zip together two of them. The positives were more important to me than the negatives, in my situation.
It took until 2004 for my body to find a balance, and until 2006 for my deficiencies to finally be under control. I’m now in the process of getting my dental work done from the malnutrition, and waiting for insurance to approve a procedure to buy the excess skin off of my torso.
Now that my body is in balance and is behaving the way it should, I can look back at all of the trials I and my family had to go through. I can honestly say that even with all of the medical issues that came from it, the alternative would have been powerful worse.
I will never regret getting weight loss surgery done, however I want others to realize this can be a very hard road to depart. There is no easy design to lose weight, diet and exercise are still an critical key to your fitness after a bariatric surgery no matter which kind you get. It should always be remembered that these surgeries are meant to be tools, not a means to an end by themselves.
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Filed under Bariatric Surgery by on Oct 4th, 2010.
More and more people are getting a gastric bypass in Mexico these days. People also get lap band surgery and other forms of weight loss surgery in Mexico. The primary reason for getting a gastric bypass in Mexico is that the cost is significantly less than in the U.S. While the cost of a gastric bypass can vary widely from surgeon to surgeon and from hospital to hospital, it often costs around $20,000 in the U.S. However, the same draw may cost only about half that in Mexico, and that includes lodging and meals as well as medical care. Lap band surgery may cost around $14,000 in the U.S., but may cost only half that amount in Mexico. Now, some people have health insurance that covers weight loss surgery, but for those that don’t, affordable surgery in Mexico can look pretty well-behaved.
Many bariatric surgeons in Mexico are highly trained, highly skilled physicians. Many are board certified in the U.S. and perform surgery at accredited hospitals that meet or even exceed U.S. standards. The reason the surgery costs less in Mexico is not because the quality of care is lower than that available in the U.S. Medical care is very expensive in the U.S. for a number of reasons, including the high rate of malpractice suits and resulting high cost of malpractice insurance, the realities of dealing with our health insurance companies, and political factors. The exact same care is often great less expensive in a number of other countries, including Costa Rica, Venezuela, and Belgium, as well as Mexico. People often disappear to these countries for a variety of medical procedures, including plastic surgery, eye surgery, and dental care, as well was weight loss surgery.
Although high quality care is available in Mexico, it is important to understand that not all doctors in Mexico are highly skilled. Of course, that is the case in the U.S. as well. Still, when traveling out of the country for surgery, it is important to do your research in order to make sure that you will be receiving the best care available. Win out where the surgeon trained and if he or she is board certified in the States. Ask how many procedures the surgeon has performed and what his or her mortality rate is (how many patients have died). Ask about his or her rate of complications.
Find out about the hospital where the surgeon performs procedures. Is it accredited, and if so, with what governing bodies? Does the hospital have physicians on duty around the clock? Does the hospital have an intensive care unit in case complications occur?
Of course, you’ll want to accomplish definite the surgeon and his or her staff are fluent in English, unless you happen to notify Spanish. Find out if the hospital staff speak English, as well. You’ll want to be able to communicate easily with nurses and other staff who will be providing your care after your surgery.
When getting a gastric bypass in Mexico, you will probably spend two or three nights in the hospital. However, the surgeon will probably want you to stay in the country for a few more days. You should expect to spend about a week in Mexico altogether. Your surgeon’s office will probably be able to recommend a hotel, and in fact, the cost of your hotel stay is often included in the total price of the surgery. It’s often a package deal. Often a nurse will visit you at the hotel to monitor your progress after the surgery. You will see the surgeon one last time before leaving the country after your week or so is up.
It’s a very trustworthy idea to take a companion with you when getting a gastric bypass in Mexico. You’ll appreciate the support and companionship, and may need some assistance after being discharged from the hospital to your hotel. Most hospitals make arrangements for a companion to be with you during your hospital halt, and provide a cot, fold out bed, or couch for your companion to sleep in your hospital room with you.
There are a couple of concerns you face when having surgery in Mexico (or any other country). One is the possibility of complications. If complications occur (and there is always a risk of complications with any surgery), the cost of your surgery may increase dramatically. Some surgeons will offer a sort of “insurance plan” to guard against this. You pay a set fee up front, and it covers any complications that may occur during or immediately after your surgery. If such a plan is available, it’s a very good idea to take it. Otherwise, be sure you have the means to cover the costs of complications if they do occur.
Another effort is follow up care. After a gastric bypass, you’ll need lifetime follow up care. For the first several months, you should survey a bariatric surgeon on a monthly basis. Then you’ll need to see the surgeon every three months or so. Then you can decrease the frequency of follow up visits to once or twice a year. At these follow up appointments, the surgeon should review your progress, discuss your diet, and perform blood tests to check for nutritional deficiencies. Now, obviously you’re not going to fly back to Mexico for all of these follow up appointments. You’ll need to find a bariatric surgeon near you that can provide your follow up. Make sure you have that arranged before having your surgery.
Some Bariatric Surgeons in Mexico:
Here are some popular bariatric surgeons in Mexico. Please don’t take this as a recommendation, though. This is just some info to get you started if you are interested in getting a gastric bypass in Mexico. Make certain you take the time to do your research and make sure you’ll be getting skilled care.
Dr. Armando Joya
http://www.drjoya.com/
Dr. F. Daniel Huacuz
http://www.huacuz.com
Dr. Roberto Rumbaut
http://www.gastricband.com/index.html
Dr. Alejandro Aguirre Wallace
http://www.derivaciongastrica.com/index.php
Dr. Ramos Kelly
http://www.wlsclinic.com
Sources:
Medical Tourism Corporation. http://www.medicaltourismco.com/medical-tourism/gastric-bypass-surgery-cost.
ThinnerTimesForum. http://www.thinnertimesforum.com/general-gastric-bypass-discussions/36138-surgery-mexico-safe.html. Is Surgery in Mexico Safe?
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Filed under Bariatric Surgery by on Aug 22nd, 2010.