Bariatric surgery is one of the most commonly performed surgeries in the United States, and each year, nearly 600,000 will undergo at least one bariatric procedure. While most people will find that their insurance covers the full cost of the procedure, there are some patients who find themselves denied coverage. If you are interested in bariatric surgery, have been searching for gastric sleeve near me and can’t get insurance approval, there are several options available to you.
Deciding to Get Weight Loss Surgery
Deciding to get weight loss surgery is no easy choice. Many people struggle with their weight for years before finally deciding to undergo bariatric surgery. Obesity can cause myriad health problems that can be difficult to fix later. Some people come in for weight loss surgery after every other method has failed to take the weight off and keep it off. Diet pills, calorie restriction, gym memberships and support groups are often effective in temporary weight loss, but they often fail as a long-term solution. Carrying extra weight for years at a time causes a strain on the body’s organs and systems and can cause lasting damage. Weight loss surgery has been proven effective in not only reducing weight to healthy levels but keeping it off long-term.
Benefits of Weight Loss Surgery
There are countless benefits to undergoing weight loss surgery. First, most patients see their “numbers” improve almost immediately. Their blood pressure returns to a healthy range, their cholesterol lowers and sleep apnea disappears. The loss of the weight makes exercise easier, and many people find that they can work out without intense pain for the first time in years.
In addition to improved “numbers,” there are non-scale victories that accompany weight loss surgery as well. A smaller body means that people can pay less for clothing post-surgery. Weight loss can also act as a confidence boost, helping patients to embark on new careers, get involved in social activities they once avoided and even develop romantic relationships. Getting to a healthy weight means that patients can enjoy experiences that were once off limits due to their size. We have many post-surgery patients report enjoying horseback riding, sky diving, hiking and zip lining.
The weight loss transformation is often all a person needs to embark on a whole new wellness lifestyle. Patients often report enjoying expanding their diet to new vegetables, fruits and whole grains, and being excited about their new fitness routines and commitment to wellness.
Obesity can also contribute to fertility challenges, and many women find it easier to achieve pregnancy after surgery.
Types of Weight Loss Surgery
There are several types of weight loss surgery available, and it is important to choose the one that matches your weight loss goals and your current state of health.
Roux-en-Y Gastric Bypass
During the Roux-en-Y gastric bypass surgery, the surgeon will separate the stomach into two sections, creating a small pouch to receive food. The small pouch is then connected directly to the intestines, sending food through the body quickly for digestion. Roux-en-Y gastric bypass leads to rapid weight loss, and is most often performed on patients who have a large amount of weight to lose. Roux-en-Y gastric bypass surgery is performed laparoscopically, and most patients recover at home within a few days to a week.
Sleeve Gastrectomy
The sleeve gastrectomy is performed by removing a portion of the stomach and leaving a portion that is shaped like a banana, or sleeve. The small intestine remains intact, and the stomach functions normally. Some patients have a large amount of weight to lose, and the Roux-en-Y gastric bypass surgery may be high risk at their current weight. The sleeve gastrectomy is often used to help reduce the patient’s weight to a healthier level so that they are a better candidate for gastric bypass.
Duodenal Switch
The duodenal switch is often used to complement vertical sleeve gastrectomy. About 18 months after gastric sleeve, the surgeon connects the remaining portion of the stomach to the small intestine resulting in caloric malabsorption. This surgery makes it hard for the body to absorb the necessary nutrients, and patients who undergo this procedure have to depend on daily vitamins for the remainder of their lives. Patients typically stay in the hospital for up to three days, and follow up regularly with their doctor to assess the state of their bodies.
Laparoscopic Adjustable Gastric Banding
Laparoscopic adjustable banding is a reversible procedure for candidates who have a smaller amount of weight to lose. In this procedure, the surgeon places a flexible band around the top portion of the stomach, drastically reducing its size and leaving only a small pouch to receive food. The band is then filled with saline, allowing the surgeon to be able to adjust it to speed up or slow down the rate of weight loss. In the year following the surgery, patients will visit their doctor monthly in order to monitor progress and adjust the band accordingly.
While the procedure is reversible, it is intended to stay in place permanently. Removing it would remove the restriction, allowing the patient to eat normally again and suffer possible regain. The best candidates for laparoscopic adjustable gastric banding are those with lower BMIs who have a smaller amount of weight to lose. Of all of the weight loss procedures, this one is the least effective in sustaining long-term weight loss.
Why Insurance Companies Deny Applicants for Surgery
Not Meeting BMI Limits
For most patients, insurance companies will only cover your procedure if your BMI (body mass index) is 40 or higher with no co-morbidities or 35 or higher with two or more co-morbidities. Co-morbidities include conditions like sleep apnea, high blood pressure and type 2 diabetes. If your BMI is not within these limits, your insurance company may refuse to pay for the surgery. There are, however, exceptions, and some patients whose BMI is lower than 35 have been able to get approval.
No Diet or Exercise Program
In order to qualify for insurance coverage, you will have to show your insurer that you made every attempt possible to lose the weight without surgery. For most insurers, this means being able to show evidence of medically supervised weight loss, a fitness program or attendance at weight loss support groups. If the insurer does not feel that your efforts to lose weight without surgery are sufficient, they may deny your application until you complete an approved weight loss program.
Your Policy Excludes Coverage
In some cases, insurance policies may exclude coverage for certain bariatric procedures. While they approve gastric banding or balloon, they may not cover gastric sleeve or bypass. When this happens, there is usually not much you can do it and you can start exploring alternatives.
You Chose the Wrong Procedure
Your insurance company may deny you for Roux-en-Y gastric bypass, but they may approve you for the gastric sleeve or laparoscopic banding. They may require you to lose weight before undergoing surgery, or start with Roux-en-Y before moving on to gastric sleeve. It is important to select the right procedure for your weight loss goals, age and overall health to maximize your chances of an insurance company approval.
Roux-en-Y Gastric Bypass
How to Pay for Bariatric Surgery Without Insurance
If you are denied coverage from your insurance company, there are several ways that you can still finance your bariatric surgery.
Personal Loans
If you have a fairly strong credit score, you may be able to qualify for a personal loan from your bank or credit union. These lenders sometimes require you to guarantee the loan with collateral in the form of a car or home. In other cases, you can get a personal loan with no required collateral. The value of your collateral often determines how much you can borrow, and in most cases you can borrow the full amount of the surgery. These personal loans often offer low interest rates and long repayment terms.
Payment Plans
It pays to ask your surgeon’s office if they offer in-house financing or payment plans for patients seeking affordable gastric sleeve or other weight loss surgeries. Some clinics will allow you to make a deposit to hold space on the surgeon’s calendar, then pay the balance before your surgery date. You can schedule the surgery for 6-12 months into the future, giving you enough time to make small payments or save the balance over time. With an in-house payment plan, you don’t have to worry about credit approval, interest or pre-payment penalties.
Health Savings Accounts
Ask your employer if they offer health savings accounts (HSAs) which can be used to finance all or a portion of the cost of surgery. HSAs allow you to use pre-tax funds to pay for cosmetic and medically-necessary procedures like bariatric surgery. Many people use their accumulated funds to pay for all or most of the costs of the surgery. With HSAs, you can make annual deposits to the account and later use that account to pay for healthcare procedures of your choosing. In addition to paying for your surgery, they can also be used for after care and supplies to support your procedure.
Prosper Healthcare Lending
Prosper Healthcare Lending is one of the premier companies for healthcare loans. Prosper Lending offers low-interest, fixed-term loans with no pre-payment penalties. The loan process is simple with a short application. You can check your eligibility without affecting your credit and receive a response immediately. With Prosper Healthcare Lending, you choose the amount you would like to borrow—up to the total cost of the surgery, and the repayment terms. After you are approved, the lender will transfer the funds into your bank account within two days.
Here at Alabama Bariatrics, we are the area leader in affordable bariatric surgery. We work with patients of all ages, health histories and goals, and we can help you get back on track with your weight loss. Weight loss surgery is among the most commonly performed medical procedures in the country, and many people enjoy healthy lives post-surgery.
Gastric Sleeve Near Me
If you are ready to take the plunge or you still need more guidance on which procedure is right for you, we invite you to join one of our informative webinars that explains the process in detail. If you are unable to attend a webinar, give our office a call and one of our specialists will gladly help you to narrow down your options. Start the journey to a healthy new life today.
https://uihc.org/health-topics/bariatric-surgery-and-insurance-faqs