Weight Loss Surgery FAQ
Some insurance policies do cover bariatric surgery. It depends on your employer, your group coverage, and if your insurance has a rider for bariatric surgery. Your insurance can be verified over the phone with your insurance provider.
The qualifications for bariatric surgery are based largely on a calculation called your Body Mass Index or BMI. This is a calculation based on your height and weight. Calculate your BMI using our tool.
You may be a candidate for weight loss surgery if:
- Your BMI is 40 or greater with or without co-morbidities (medical conditions)
- Your BMI is 35 or greater with co-morbidities (medical conditions)
- Regardless of your BMI, bariatric surgery should be reserved for those who have tried non-surgical methods of weight-loss and have been unsuccessful.
A number of studies suggest that patients regain weight due to the gradual enlargement of the surgically altered small stomach pouch and stoma, the connection between the stomach and small intestine. When the Roux-en-Y procedure is performed, the stomach and stoma are made very small, which slows the passage of food and creates a feeling of fullness after just a small volume of food is eaten. It is believed that when the stomach pouch and stoma gradually enlarge, the feeling of fullness is no longer present, patients can eat larger meals, and weight gain occurs.
Typically, patients stay less than 23 hours. You may be discharged the same day if the procedure was done early in the morning, or you may stay overnight. Your surgeon will make the determination following your procedure.
It is anticipated that patients will feel little or no discomfort from the procedure. To date, the only noted side effects have been short-term sore throat, swollen tongue and lip pain from the insertion of the instruments into the mouth.
It is too soon to estimate the likely procedure success rate. However, to date, the procedure has been well tolerated and the first few patients have experienced weight loss within the first 4 weeks and a reduction in food volume capacity.
Typically patients return to normal activity within a few days of their procedure. Your doctor will give you specific instructions. In addition, patients are asked to follow a post bariatric surgery diet and exercise plan, similar to the regimen prescribed following the initial bypass surgery. In addition, follow-up appointments with your doctor and regular visits with bariatric support staff will be required.
As with gastric bypass surgery, coverage will vary depending upon the insurance provider. A specialist in your physician’s office will discuss your plan with you. In the event insurance will not cover the procedure, financing options may be available. Check with your surgeon’s office for information on possible financing programs as well as potential tax advantages for any expenses you may incur.
The cost for the procedure will vary depending upon where the procedure is performed, how long you stay in the facility and other factors. Your doctor or the program coordinator will be able to give you an estimate of the total cost.
This procedure is one of the first of many potential applications for incisionless surgery. Incisionless surgery is considered the next wave in minimally invasive procedures and, in addition to obesity, it has generated interest among physicians in areas such as GERD, GI cancer and NOTES (Natural Orifice Translumenal Endoscopic Surgery).