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Long Island Bariatrics |
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| What is obesity? |
| Why treat it? |
| BMI chart |
| Will they approve me for surgery? |
| Other FAQs |
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Obesity, as defined by the National Institute of Health, is a BMI of greater
than 30. BMI is a persons' weight in kilograms divided by their height in
meters squared (see chart below). Morbid obesity is a BMI of greater than
39. Both genetic, behavioral, and environmental factors contribute to this
disease which currently affects 60 million U.S. adults, 15.3% of 6 -11 year
olds, and 15.5% of 12 -19 year olds. Obesity is the leading cause
of preventable death in America.
Compared with individuals in a normal weight category, those who are
overweight or obese are at greater risk for many diseases including diabetes
hypertension, cardiovascular diseases, stroke gastrointestinal reflux disease,
nonalcoholic steatohepatitis, gout, osteoarthritis, dyslipidemia, gallbladder
disease, sleep apnea, and certain cancers. Obesity also lowers life expectancy,
interferes with enjoyment of life activities, and is correlated with lower
socioeconomic advancement.
The following links will help you determine insurance requirements for bariatric surgery. We will update
this list as companies post information on their websites.
Click on the links for more policy information. (check back for updates)
Empire BCBS 1199 Aetna Medicare UnitedHealthcare
GHI Oxford
Will they approve me for surgery?
Most insurance carriers will approve you for surgery if you meet the qualifications listed above
for BMI and comorbid illness. Your surgeon needs to have a well designed letter and support
documents in order to get approval the first time. You don't want to need to appeal, because
there are a limited number of times you can do this, so getting it right the first time is of the
utmost importance. Some insurers only approve Roux-en-Y so check the links above.
Weight loss will vary depending on the individual and the type of operation. In general those
who undergo Roux-en-Y will lose weight at about 8-15lbs per week at first, and this will taper
over the first six months. Weight loss thereafter will be slower, usually reaching a peak by 18
to 24 months. With a lap-band the weight loss is slower. For the first month, while the band
remains uninflated, there is not much weight loss. After a few adjustments, weight loss should
occur at between one and three pounds per week. This may continue for up to five years assuming
continued band adjustments.
Q. Which procedure should I get, I can't decide?
A. Any surgical procedure to treat clinically severe obesity is better than no procedure, assuming
non surgical methods have failed. So the choice of procedure isn't as important as diligent
follow up, continued good food choices, regular exercise, and support group attendance.
All things being equal, the gastric bypass procedure has been proven superior to lap-band in
amount of weight lost, while complications may be less with the lap-band.
Q. How long do I need to wait before I can get surgery?
A. This depends on your surgeon's schedule, and which insurance you have. It at least takes
one to two months to complete preoperative evaluations. Some insurers require 6 months
of medically supervised weight loss before approving surgery.
Q. My medical doctor and my spouse don't think I should get the bypass, they have seen disasters.
A. Complications, even death, can occur with any surgery, and gastric bypass or lap band are no
different. Unfortunately what some medical professionals themselves don't realize is that there
are over 400,000 deaths in the United States each year due to obesity. Obesity has just
surpassed smoking as the leading cause of preventable death for Americans. Therefore, death
is far more likely without surgery than with it for BMI greater than 35.
Q. What happens to the rest of the stomach after bypass?
A. The remainder of the stomach (stomach remnant) after gastric bypass is left undisturbed. It
still functions, because it is supplied with blood from arteries, and it produces gastric juices and
hormones that are still important for digestion.
Q. What if I lose too much weight?
A. This would be an extremely rare phenomenon, given that without complications such as
shrinking of the connection between the stomach and small intestine, or unrelieved diarrhea due
to excessive malabsorption, the body adjusts so that final weight loss averages 65%-85% of original
excess weight.
Q. No surgeons accept my insurance or my insurance won't pay. What can I do?
A. It is unfortunate that some insurers don't value their patients' lives enough to approve surgery. Or
they may have forced some surgeons not to accept their coverage due to unacceptably low physician
payment. First, you should complain to your New York government that greedy lawyers and insurance
companies are making healthcare inaccessible for Americans, and that you support tort reform. (Visit
the Medical Society of the State of New York for more information). Second, you should value your
own health more than your HMO by seeking ways to fund the surgery. Your surgeon may have
resources for you. Isn't your life worth it?
Q. Why do I need all these preoperative tests? Can't I skip some?
A. There are two main goals in the preoperative evaluation prior to bariatric surgery: 1. maximizing
safety of the operation, and 2. obtaining your insurers approval. To meet these requirements,
detailed testing is required and might include: consultations with other physicians, sleep studies,
radiologic tests (xray or ultrasound), laboratory testing, and others. You should value a safe
operation as much as your surgeon, so make those appointments, and finish strong.
Q. I'm interested in surgery, what is the usual way to proceed?
A. Just pick up the phone and give us a call. Our practice is dedicated to making this
difficult choice easier by helping you every step of the way. Whether it be working with
your insurance company for referrals and approvals, or educating you and your family.
Q. I'm not sure if I'm interested in surgery, how do I figure this out?
A. We're not just here to operate. We're here to educate. Allow us to provide you with
honest and complete information about non surgical and surgical weight loss. Then YOU
can decide which is right for you.
How can I get more information?
Come to a free education session
or
Call us for a password to our Internet Bariatric Education Series. This
new system will allow you to completely evaluate bariatric surgical
options, your pre and postoperative course, and much more.
or
Make an appointment!
Call 1-800-979-4308