Will Insurance Cover Bariatric Lap-Band Surgery?

Bariatric Lap-Band surgery is one of the safest surgeries to help with weight loss, but it can also be expensive too (as with most any type of surgery). For this reason, many insurances (such as Blue Cross (in some states), Humana, One Health, Medicaid, First Health, Tufts Health Plan, United Healthcare, Oxford Health Plan, and American Family Insurance) have been known to cover for bariatric care. If covered, insurances will either cover for complete care or partial care.

If you are not covered by your insurance company, it may not hurt to talk to your employer. Lots of times it is the employer that decides what will or will not be covered for their employees. It is usually not difficult for an employer to make a change in an employee's insurance package. It is, however, very difficult for an employee to make a change since it is the employer that purchases the insurance packages in bulk and therefore, already has a deal set up with the insurance company.

Not even bariatric centers can get insurance companies to change a policy that is already written, no matter how qualified the person is for getting a bariatric procedure done. However, it will be much easier for your employer to change your insurance policy if you do qualify for bariatric procedures because of medical reasons.

Even if your insurance won't cover for bariatric care, there are other options that are usually available. Many centers have "out-of-network" benefits you can take advantage of, and financial plans through third parties that will help allow you to pay. Bariatric centers will generally try to work with you and your financial needs.

The Gastric Bypass Diet for Bariatric Patients - What to Expect

Gastric bypass patients must be committed to following the dietary guidelines recommended by their doctor. The gastric bypass diet is designed to maximize weight loss, while providing the body with the nutrients it needs to be healthy. Although specific diet plans can vary from patient to patient and doctor to doctor, the following information outlines some of the generally accepted dietary guidelines that are encountered by gastric bypass patients following surgery.

Eating Habits

The changes made to the gastrointestinal tract will require that gastric bypass patients make permanent changes to the way they eat. Adopting new eating habits is just as necessary as choosing healthy foods to eat. Patients will need to schedule meal times, eat small amounts, eat slowly, and avoid snacking. Calories will need to severely limited (about 800 calories per day for the first 1 to 2 years during weight loss and 1000 - 1200 per day thereafter for weight maintenance) and certain foods will need to be eliminated from the diet.

Nutrients

Protein is the most important nutrient in the gastric bypass diet. It is needed by the body to function properly, protect muscle tissue, and burn fat reserves. When eating a meal, the protein food items should be eaten first, in case you feel full and cannot finish. Some gastric bypass diet plans encourage the regular use of protein supplements, but in most cases it is best to get your protein from regular foods. The recommended protein intake typically ranges from 50 to 70 grams per day.

Carbohydrates, which are the body's main fuel source, are also an important part of a balanced diet. While it's true that some types of carbohydrates are unhealthy and should be avoided, including starchy foods such as bread products, rice, and pasta, and sugary foods, not all carbohydrates are bad. Nutrient-rich fruits and vegetables are also carbohydrates and a healthy addition to the diet.

Meals

Meals in the gastric bypass diet will primarily consist of protein-rich foods, including lean meats (chicken, turkey, fish), low-fat dairy products (yogurt, cottage cheese), eggs, and soy products, as well as a variety of nutrient-rich fruits and vegetables. Since the amount of food eaten each day is very limited, it is important to eat only healthy and nutritious food.

Fluids

Fluids are an essential aspect of any diet, but especially for the gastric bypass patient. Patients need to drink plenty of liquids, about six to eight cups a day, to keep from becoming dehydrated. All liquids must be consumed between meals and not with meals or within 30 minutes before or after a meal. Liquids should be sipped slowly and be limited to low-calorie, non-carbonated beverages.

Vitamins and Minerals

Following gastric bypass surgery, the amount of calories and nutrients absorbed from food is reduced due to the changes made to the gastrointestinal tract. While the body can function on the reduced calories, it needs a certain levels of nutrients for proper health. Gastric bypass patients will need to take nutritional supplements for life in order to supply the body with the vitamins and minerals it needs to function properly and to prevent deficiencies that can lead to serious health consequences.

Foods to Avoid

Some foods will need to eliminated from the diet in order to maximize weight loss efforts. The gastric bypass diet should not include sugary foods or high-fat foods as they add excessive calories without providing any nutritional benefits. Other foods should be avoided because they are problematic to the altered gastrointestinal tract and can cause eating discomfort or digestive difficulties.

Lap Band Surgery - Appealing Insurance Denials for Bariatric Surgery

It can be very discouraging if your insurance company denies the pre-authorization request for coverage of lap band surgery. If you receive a denial, however, don't give up! Instead, appeal the decision. Like many other lap band patients who were initially denied coverage, you too may find that it is possible to gain approval through the appeals process.

Denial of Coverage Notification

When you receive a notification of denial, the first step towards filing an appeal is to determine why the insurance company denied your request. Once you know the exact reason why coverage was denied, then you can proceed with gathering the information needed to overturn the initial decision.

When you follow-up with the insurance company for details, be polite yet persistent. Not only do you want to find out why the surgery was denied, but you want to find out what information the insurance company requires for approval. The insurance company may not make it easy for you, but don't let that stop you from working through the appeal process.

Paperwork and Documentation

Many pre-authorization requests for coverage of bariatric surgery are denied simply because of incomplete paperwork and lack of proper documentation. While you may know that you have struggled with obesity for years and have tried to lose weight with diet, exercise and medically supervised plans, the insurance company will not know that unless you provide them with all the "evidence" to this effect, including documentation of doctor visits for weight loss, receipts of diet and exercise programs, and medical history records. Since there is no such thing as providing too much relevant information, be thorough and submit all the proof you have of previous weight loss attempts. The documentation you provide to the insurance company can make a difference as to whether or not you are granted coverage for surgery.

Meeting Patient Criteria and Medical Necessity

Coverage for lap band surgery often depends on whether or not an individual meets The National Institutes of Health (NIH) patient criteria for weight loss surgery and if the procedure is considered a medical necessity. Both of these conditions can be established by your doctor and presented to the insurance company in a Letter of Medical Necessity. The statement your doctor provides to the insurance company about your obesity and weight related health problems is very important in showing your insurance company the medical necessity of weight loss surgery. Your doctor should be more than willing to write a letter to your insurance company as a way of helping you present your case for coverage of lap band surgery, both in the initial request and in the appeals process.

Appealing an Exclusion for Weight Loss Surgery

Even if your insurance plan excludes "obesity surgery" or "treatment of obesity" it may still be possible to appeal and win. Bariatric surgery has been shown to be an effective treatment for many other diseases, including type 2 diabetes, hypertension (high blood pressure), and obstructive sleep apnea. Since these diseases are usually covered by health insurance, the appeal would be based on your doctor's opinion that bariatric surgery is the best method for treating your health problems. Documentation should be presented to the insurance company showing that other treatment methods have not been effective in controlling or curing the disease.

Writing An Insurance Appeal Letter

When you are informed of a denial there is usually a date limit to respond. While it is important to appeal within a timely manner, it is also important to respond effectively. When appealing, write a letter that is factual and persuasive, yet pleasant and polite. Make sure you include all the relevant information and include the supporting documentation to establish patient criteria and medical necessity. Make copies of everything you send for your own records and then send the package with tracking information for proof of mailing.

Learn About The Bariatric Lap Band Procedure To See If It Is Right For You

The bariatric Lap-Band procedure really is quite simple. This surgery involves a band that tightens around the top part of the stomach to limit food intake. The band that will tighten the stomach is passed through small abdominal incisions. The stomach is not cut or punctured in any way. The surgery is painless under general anesthesia and only lasts around 30-60 minutes with a fast recovery. Recovery will generally not take longer than a 48 hour hospital stay.

The gastric band has a balloon- type device inside to allow the band to inflate or deflate as needed. The surgical procedure is done in a way that allows the doctor to inflate or deflate the device easily without surgery. Therefore, as the patient loses weight, the band can easily be tightened to adjust for the extra weight loss. If the band ends up getting too tight, again, the doctor can deflate it to loosen it the same way. If the desired amount of weight is lost and the patient is able to keep it off without the band, the band can easily be removed. The stomach should then return to normal. So, the Lap-Band procedure is completely reversible if the patient no longer needs it.

Even with bariatric procedures and surgeries, guidelines and doctor's orders must be followed to ensure success. If the patient is dedicated to following the doctor's orders while at home, goals will most likely be achieved. It is important to continue with the doctor's recommended dietary and fitness plans even after the device is removed to keep the weight off.

How And When Bariatric Lap-Band Surgery Can Fail

Bariatric Lap-Band surgery is a simple procedure that involves putting a band around the top part of the stomach to tighten the stomach. The purpose of tightening the stomach (much like a tight belt) is to limit food intake. This surgery is one of the safest surgeries available since the stomach is not cut, punctured, or permanently reconfigured in any way. However, there are still things that can go wrong with this procedure. The gastric band that is inserted could shift position, erode into the stomach, break, or cut into the stomach. Although these risks are rare, keep in mind that there are many risks associated with any type of surgery that may be unforeseen, but most of them can be treated.

Bariatric Lap-Band failure usually only fails when the patient lacks desire, determination, and patience. There are some patients who have the band removed because of complications that, with patience, could have been easily treated and cured (such as complications that cause the patient to feel ill). The most important factor that decides the success rate and the amount of success achieved boils down to the patient's desire to lose weight. If the patient does not follow all of the instructions and orders from the doctor while away from the doctor, then the patient won't have as much success, if any at all.

Even though the gastric band around the stomach makes an increased amount of food intake harder to achieve, the patient must still follow the doctor's dietary and fitness plans. There are foods and drinks the patient is advised to stay away from, and portion sizes the patient must not exceed, even with the band still on. The band makes it easier to follow a more strict dietary plan, but patients still have to do their part or the plan will fail. Lack of desire and determination is the cause of most failures. Therefore, as long as the patient is willing to obey the doctor's instructions, success will be very likely.

How Much Do Bariatric Lap-Band Surgeries Generally Cost?

The cost of bariatric Lap-Band surgeries can vary significantly depending on where you go, but you can expect to pay around 10,000 dollars. Some places in the United States will even charge around 30,000, so be sure to shop around if you are trying to get a good deal! Many bariatric centers offer different payment plans too, so do your homework before deciding which will be the best deal overall.

Insurances will lots of times cover for bariatric care, especially if you qualify for it medically. If you are not covered, then lots of times your employer can make the change for you if you are covered under the company's insurance plan. If for some reason you are unable to get your insurance to cover at least some of the costs, there will usually be other options available to you. However, going through your insurance will usually be your best bet because you never know when complications could arise. In that situation, the cost could end up being much more than you had anticipated.

Lots of bariatric centers have "out-of-network" insurance plans you can use. It won't be as good as using your own insurance that they are networked with, but it will at least help to cut costs. Many bariatric centers also have additional financial payment plans to help enable you to pay, and they may save you money too. These financial plans that bariatric centers offer are usually through third parties that are in business with the center. If your insurance won't cover for bariatric care, be sure to explore all payment options and you may be surprised how much of the cost you can defray.

From Obesity Causes to Bariatric Surgery

It is important for us to know the main causes that lead us to obesity.

Traced to gens obesity is commonly named genetic obesity. Medical studies concluded that obesity is inherited because it has great genetic component. A higher appetite might also come from your genes or from the early educational state in the family.

Certain illnesses can cause obesity. Hypothyroidism is the main sickness a doctor would look for, in an obese patient. Thyroid used to be blamed for most of our illegitimate weight gains but, sometimes, even if the thyroid function is not correct, it is influenced by other glands malfunction. If the situation is so, the real cause of weight gain is really hard to find. Other illness to blame for obesity is Cushings Syndrome.

All emotional problems or mental illnesses are possible culpable factors for one person to become overweight. Whatever the main reason for depression is, it can lead to obesity for the most of us because it causes alimentary disorders.

At the beginning of everyone's obesity is, in most situations, poor eating habits and a low level of physical activity so we can say that the environment we live in might be blamed for obesity. If physical work is no more a part of our life, it is indicated to try to do some other kind of physical activities, starting from an early age. Nowadays, foods have a low cost so abusing food is no more a money problem. High calories foods, contained in small amounts of foodstuff are also to be blamed. Sugars and fats contain low nutrients and many empty calories so your body will transmits to the brain the information that he lacks vital nutrients, like minerals and vitamins and we will feel hunger at a short time after a fatty or sugary meal is taken.

Searching the main cause that led you to obesity is the key to a significant weight loss. There are situations when a person's weight can't get lower without surgery, or, if the patient obtain some weight loss, his efforts are too high and satisfaction is too low, especially if the weight lose can't be preserved for a reasonable period of time and the body tends to quickly come back to its initial fat form. Talking to a bariatric doctor will help you decide if it is the right moment to try a weight loss surgery and which of the opportunities the modern science offers, is the most appropriate for you.