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eLearning Series:
Your Most Popular Insurance Questions
Answers For Health and Home
Insurance
( 50 articles
in this series )
Gastric Bypass
Surgery:
When is it Covered by Insurance?
Overweight and obesity is a major health crisis
in North America. More and more adults and children are struggling
with the weight and the array of health problems that is associated
with carrying around dangerous and unwanted pounds. The weight
loss/diet industry is a multi-billion dollar business, with
desperate people willing to try anything from books to commercial
diet plans and pills in order to lose weight for health and
beauty reasons. One of the more drastic and expensive
weight loss treatments is gastric bypass surgery. This controversial
surgery can be life-saving, life-changing or life-taking, but
it always costs a lot and not everyone can afford the multi-thousand
dollar price tag which begs to question: will my insurance
company pay for gastric bypass surgery?
Gastric
bypass surgery is an extremely invasive procedure that
involves shrinking the stomach so that only a small pouch
remains. Effectively, patients that have undergone successful
gastric bypass surgery are unable to eat more than a few tablespoons
of food at a time. The technique has been proven effective
for quickly reducing the mass of morbidly obese people for
whom regular activity and nutritional monitoring has not worked.
The surgery is not a quick fix for minor weight loss, however.
It is a serious procedure applied in only serious cases. To
qualify for the surgery, whether covered by health care insurance
or not, you must have a body mass index (BMI) greater than
40. For an average man, that means about 100 pounds
overweight and 80 pounds over weight for an average woman. Individuals
with a slightly lower BMI may also be considered for gastric
bypass surgery if they also have a serious condition, such
as diabetes or heart disease that can be worsened by obesity.
Surgery candidates must also realize the severity of changes
gastric bypass surgery will mean in terms of lifestyle changes
and responsibility.
In cases where gastric bypass surgery is deemed medically
necessary, most health care insurance companies will
pay for the procedure, even if the initial application is refused.
If you have to fight to have the surgery covered, arm yourself
with information and support from your physician, along with
any information you can gather about the potential savings
in future medical costs as a result of the weight you would
lose if the surgery is carried out. There are abundant studies
from reputable organizations that trumpet the benefits of weight
loss to the prevention and reduction of several associated
problems such heart attack, stroke, Type 2 diabetes (so-called
adult-onset diabetes), and sleep apnea to name a few.
Even though most insurance companies will agree to fund gastric
bypass surgery that has been deemed necessary, there are some
plans that do not pay for it or will do so under certain circumstances
only. These circumstances, like proven attempts to lose weight
in other ways, may need to be authenticated by your physician.
Review your policy to find out exactly what coverage
you qualify for, or speak to your insurance provider for a more precise
explanation. Get the information in writing, if possible.
Even if you are the perfect candidate for surgery, do
not expect a quick process. Between the time you contact your insurance
provider about possible gastric surgery and the time you actually
get the surgery, many months may have passed.
While it can act as a catalyst for fantastic weight loss,
gastric bypass is a serious surgery, and as a result, you may
be at risk of post-operative complications ranging from mild
infection or discomfort to digestive issues. One study has
produced the alarming statistic that up to 98 percent of gastric
bypass recipients experience at least one post-operative complication
or side effect. It is important that you know, in advance,
how your health insurance provider would handle any costs associated
with post-operative complications associated the bypass surgery.
Will you receive blanket approval for any additional care that
may be necessary or will you have to secure case-by-case approval
for each new procedure or measure?
Once again, gastric bypass surgery is a potentially dangerous
procedure that requires serious thought and consideration.
Health insurance coverage may be one of the elements of your
decision, but it shouldn’t be the only thing you think about. # # # # #
SolveYourProblem.com : 2005
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