Bariatric surgery is not for everyone – this we already knew. That it is also complex, costly, risky and a major physical and emotional commitment we may not have understood. Anyone seriously considering such a procedure needs plenty of soundly researched, up-to-date information, a team of health care professionals he or she trusts and respects, patience and support from family and loved ones, and a fierce determination to maintain that weight loss for the rest of their lives. It may sound simple – go in, go under, wake up skinny, go home happy – but that’s not how it works.
We’ve already covered the basics, the various options, the theories behind a surgical approach to weight loss. Here are a few more things to think about.
Bariatric surgery is performed through an ‘open’ method, which involves cutting the stomach in the more or less traditional manner, or by laparoscopy. With this latter approach, surgeons insert instruments through 1/2-inch incisions and guide a small camera that sends images to a monitor. As much bariatric surgery as possible is laparoscopic today because it uses smaller cuts, creates less tissue damage, and has fewer problems, like post-op hernias. All of this means patients go home sooner – a good thing. However, there are individuals for whom laparoscopy is not possible – the extremely obese, those with complex medical problems such as heart and lung disease, or those who have had previous stomach surgery.
All surgery involves side effects. Right after the procedures, the risks include bleeding, infection, diarrhea, blood clots in the legs than can travel to the heart and lungs and leaks from the site where the intestines were sewn together. Side effects that show up a bit later include nutrients being poorly absorbed. Patients must take their vitamins and minerals precisely as prescribed. Failure to follow these directions may bring on diseases that permanently damage the nervous system. Pellagra, caused by a lack of vitamin B3 (niacin), beriberi, the result of a deficiency of vitamin B1 (thiamine) and kwashiorkor, caused by a lack of protein, are among these diseases.
Other problems that show up later include strictures, which is a narrowing at the sites where the intestine is joined, and hernias (mentioned above). A hernia means that part of an internal organ is bulging through a weak spot in a muscle. Bariatric surgery patients might face one of two kinds of hernias. An incisional hernia is a weakness that protrudes from the abdominal wall’s connective tissue, potentially causing bowel blockage. An internal hernia happens when the small bowel is displaced into pockets in the abdomen’s lining. These pockets are created by sewing together the intestines. Internal hernias – considered to be more dangerous than the incisional sorts – are dealt with promptly to ward off even more serious problems.
Bariatric surgery is expensive, costing from $25,00 to $30,000 or more. Surgeons and clinics sometimes offer payment plans or have financing companies they recommend; the practice staff members should be able to help with insurance questions. Many private insurance companies will cover weight loss surgery, but only if a primary care doctor deems it medically necessary and he or she provides proper documentation to back this up – no small requirement. A doctor’s letter of medical necessity sent to an insurance carrier should include at least the following:
- The patient’s height, weight history and BMI.
- The patient’s current medications.
- A very detailed description of the patient’s obesity-related health conditions, including records of treatment. The health conditions may include diabetes, high blood pressure, sleep apnea, heart and blood vessel disease, arthritis, high cholesterol and gastroesophageal reflux.
- A detailed accounting of how obesity affects the patient’s daily activities.
- A very detailed history of the patient’s past efforts to diet and lose weight. Most insurers require irrefutable evidence and documentation of participation in a physician-supervised diet plan – and most companies require the submission of at least six months’ worth of notes from that supervising doctor.
- A history of exercise programs, including documentation of gym membership.
Remember, too, that even if a first try to authorize coverage is denied, there is always the option to appeal. Be sure to consult with an experienced health agent familiar with your insurance carrier or other trusted professional. And most insurance companies do not cover many of the things that come up after the surgery, including body contouring procedures, the cost of diet and fitness plans, nutritional supplements and behavioral modification therapy.
The US Department of Health and Human Services has made it a bit easier to obtain Medicare coverage for obesity treatments, and bariatric surgery may be covered under the following conditions:
- A patient has at least one health problem directly linked to obesity.
- The proposed procedure is suitable for a patient’s medical condition.
- Approved physicians and facilities are involved.
Check with your regional Medicare, Medicaid or health insurance office to find out more about the available options.