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About Us Services Patients Providers |
Am I a Candidate for Weight Loss Surgery?Obesity results from the excessive accumulation of fat that exceeds the body's skeletal and physical standards. Severe obesity, sometimes known as "morbid obesity", is defined according to the Metropolitan Life Insurance Company height and weight tables as being 100 pounds or 100 percent above ideal body weight (IBW). According to the National Institutes of Health, an increase in 20 percent or more above your ideal body weight is the point at which excess weight becomes a health risk. Today 97 million Americans, more than one-third of the adult population, are overweight or obese. An estimated five to 10 million of those are considered morbidly obese. According to the New National Heart, Lung, Blood Institute obesity guidelines, Body Mass Index (BMI) is the best known assessment of a person’s obesity since it is simple to use, accurate in determining the degree of obesity, takes both height and weight into consideration and applies to both men and women. BMI is used extensively in managing surgical weight reduction. What does it mean?
You are a candidate for surgical weight loss if you:
Our multidisciplinary consultation process involves a thorough patient evaluation through an initial questionnaire that will be mailed to you prior to your clinic visit. Our goals in the consultation appointment are three-fold:
The First Appointment You should bring:
Please come early to the appointment to complete the paperwork. After watching the informational video, you will have an interview with (and be examined by) a surgeon. He will discuss and clarify your medical history, conduct a physical examination, and go into a detailed discussion about gastric bypass surgery in your specific case. He will let you know if you are a reasonable candidate for gastric bypass to ensure that you are as informed as possible about the procedure and its ramifications. If your surgeon determines you are an appropriate candidate for surgery, he will make a written request to your insurance company to approve coverage for obesity surgery. Further consultations may be necessary to ensure your health is stable and you can undergo general anesthesia for the surgery. These may include appointments with a cardiologist, psychologist, and internist, as well as tests including sleep study, endocrine evaluation, etc. Pre-Operative Visit During this visit to the hospital for pre-operative testing, you will also be oriented to the hospital admitting area, what time you would arrive on the day of surgery, and the ward in which you will recover from surgery. If your spouse or other loved ones were not able to attend the first appointment, they are highly encouraged to come to this one. We encourage family members to be fully informed about the surgery. The decision about whether to undertake obesity surgery is fairly complex and most importantly very personal. You must understand that weight loss surgery is a major undertaking and though most patients enjoy an improvement in obesity-related health conditions (such as mobility, self-image and self-esteem) after the successful results of weight loss surgery, these results should not be the overriding motivation for having the procedure. Deciding to undergo a bariatric surgical procedure will change your life in a dramatic and permanent way – and there is no such thing as too much careful consideration. Even if you are interested in having surgery, your goals should be to live better, healthier and longer. For these reasons, you should make the decision to have weight loss surgery only after careful consideration and consultation with an experienced bariatric surgeon or a knowledgeable family physician. A qualified surgeon should answer your questions clearly and explain the exact details of the procedure, the extent of the recovery period and the reality of the follow-up care that will be required. They may, as part of routine evaluation for weight loss surgery, require that you consult with a dietician/nutritionist and a psychiatrist/therapist. This is to help establish a clear understanding of the post-operative changes in behavior that are essential for long-term success. It is important to remember that there are no ironclad guarantees in any kind of medicine or surgery. There can be unexpected outcomes in even the simplest procedures. What can be said, however, is that weight loss surgery will only succeed when the patient makes a lifelong commitment. Some of the challenges facing a person after weight loss surgery can be unexpected. Lifestyle changes can strain relationships within families and between married couples. To help patients achieve their goals and deal with the changes surgery and weight loss can bring, most bariatric surgeons offer follow-up care that includes support groups, dieticians and other forms of continuing education. Ultimately, the decision to have the procedure is up to you. After having heard all the information, you must decide if the benefits outweigh the side effects and potential complications. This surgery is only a tool. Your ultimate success depends on strict adherence to the recommended dietary, exercise and lifestyle changes. Some of the following are considerations that go into the decision making process - whether surgery is offered as an option, and whether you choose the surgical option.
Paying for Weight Loss Surgery At some point, after you have spent time exploring the option of weight loss surgery, you will need to determine how to pay for the procedure. Will my health insurance pay for the procedure? Although most insurance companies in Iowa pay for bariatric surgery if the need is documented by the surgeon, many of them require the following:
Please check with your health care plan to determine whether you meet their criteria. If you do not have insurance and are interested in participating in our self pay program, please call 319-356-1887 for information. A growing number of states have passed legislation requiring insurance companies to provide benefits for weight loss surgery for patients that meet the National Institutes of Health surgical criteria. While insurance coverage for weight loss surgery is widespread, it often requires a lengthy and complicated approval process. The best chance for obtaining approval for insurance coverage comes from working together with your surgeon and other experts. Here are some of the key steps you should take to obtain insurance coverage for weight loss surgery:
Thirty days is the standard time for an insurance provider to respond to your request. You should initiate a follow-up if you have not heard from your insurance company in that time. Most insurance companies recognize the health consequences of obesity and cover the costs of the surgical management of weight loss in qualifying patients. However, every insurance plan is different. Because of this, we coordinate patients' insurance applications. Once the physician has recommended surgery, we start the process to seek insurance authorization. We begin by sending a letter to the patient's insurance company requesting coverage for the surgery. It usually takes about four to six weeks for the insurance company to approve the application. We will call the patient once we receive word from the insurance company of approval or denial. If the coverage is approved, a surgery date and pre-op appointment is scheduled for the patient. If coverage is denied, we resubmit the application and go through the appeal process with the insurance company. Even if your initial request for pre-authorization is not approved, you still have options available. Insurers provide an appeal process that allows you to address each specific reason they have given for denying your request. It is important that you reply quickly. It is also recommended that, at this point, you enlist the help of an experienced insurance attorney or insurance advocate to properly navigate the complexities of the appeal process. Some insurers place limits on the number of appeals you may make, so it is important to be well prepared and that you clearly understand the appeal rules of your specific plan.
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| Last modification date:
Wed Dec 13 14:11:54 2006
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