As many who read this blog surely know, getting insurance to cover bariatric surgery has been a difficult battle in the past. Most insurers have bariatric carve outs or total exclusions for many, if not all, of their plans. This is changing slowly, but there are signs of hope for those currently awaiting coverage.
The first thing to look at is the increasing amounts of data pouring into the market. As time goes by and more people have surgery, the more data gets into the hands of insurers who determine what is covered and employers whose demand for various services often leads to coverage policy changes. So far all of that data has pointed to increased healthcare costs for those with BMI >35 which is getting the attention of HR managers looking to cut the costs of their plan.
The second is that some insurers have already made the decision to start covering the gastric sleeve. This is important primarily because the insurance world is a very “follow-the-leader” type place. Meaning when one large insurer does something, it generally causes others to do the same to keep up. The May issue of Bariatric Times contains an article noting the ASMBS’s support of the recent decisions to cover the gastric sleeve by both Aetna and United Healthcare. Definitely a good sign going forward.
Though there is a lot of work left to do before weight-loss surgery is treated as a necessary medical procedure, there are positive signs on the horizon.
If you have questions about your bariatric insurance coverage, we are happy to help whether or not you are a current patient with us. Give us a call today!
As Chief Operating Officer of WeightWise, one of the big parts of my job is determining what our patients want and how we can best deliver that to them. We get feedback in a variety of ways including everything from encouraging Facebook posts to angry emails to patients stopping one of our employees in the hall. As much as possible, I try to respond to all of it in one form or another so people know they’ve at least been heard.
In my initial post for the blog, I’d like to call attention to a couple of comments we’ve received on recent customer satisfaction surveys – these are both direct quotes:
“Great experience, only place in the world to do this”
“Love you and the new live you’ve given me –> Thank You, Thank You”
I love getting these comments and we strive to make each and every patient feel this way. I’d like to think that we make every patient this happy and that things always run this smoothly. The facts are though that they don’t. That’s where you come in. In my portion of the blog I am going to try to explain why we operate the way we do, why problems pop up and what we are doing to correct them and even touch on more general, but timely healthcare issues such as insurance, access and quality care. So if you have questions, comments or issues you’d like to see discussed, please let me know either in the comments below or via email or Facebook. I look forward to hearing from you!
Dining out is often an enjoyable social experience, however, bariatric surgery patients may experience difficulty in deciding what to order. Don’t be discouraged by a large menu. Look to order the foods that fit into your dietary recommendations. Everyone serves meats and vegetables! It is absolutely possible to eat healthfully while dining out; the important factor is choosing sensible options.
Here are some helpful tips for dining out:
- Always center your meal around a protein food. Chicken, beef, fish. Avoid anything breaded or fried.
- Substitute starchy sides for non-starchy vegetables. For example, steamed or roasted vegetables instead of a baked potato.
- Ask for salad dressings or other condiments on the side, and be mindful to use sparingly.
- Ask for half portions, share with a friend, or ask ahead of time for a to-go box and put half of your meal in the box so you are not tempted to overeat.
- Avoid children’s menus. While portion sizes tend to be smaller, the foods offered are not always the best choice (such as chicken fingers, hot dogs, or macaroni and cheese).
- Ask that breads or chips brought before the meal not be served. Or chew on sugar free gum until your meal comes.
- Remember to be conscious about your eating! It can be easy to be distracted with visiting while eating out, so be diligent about keeping your bite sizes small, chewing well, and pausing in between your bites.
Ideal Body Weight (IBW) calculations used in and around weight loss surgery hold special meaning. One might think, incorrectly in this situation, Ideal Body Weight would be an ideal weight after surgery or the “goal” weight after surgery. NOT SO. The ideal body weight calculation we use is based on the New York Life tables from the 1960’s. Actuarials looked at humans at every height, and observed the life span of folks at varying weights for that height. The ideal body weight was the weight of those people who lived the longest.
So, those life tables probably do still have significance – even though the calculations seem “skinny.” We have generally become accustomed to a more plump body habitus.
Bariatric Surgeons use IBW to calculate the amount of weight someone is overweight. Because we all use the same calculation for IBW, the amount of excess weight calculated for each patient is the same in Oklahoma, California, New York, London, Japan etc. In this way, we can compare outcomes in a meaningful way (apples to apples if you will).
IBW is not a goal, but a normalizing number. Only about 1% of people get down to their IBW after bariatric operations. One-half of those folks are in good health, they have just lost a lot of weight; the other half usually has some medical issue – physiologic, psychologic or sociologic.
Bariatric operations in general allow people to lose 55% (band) to 75% (gastric bypass, gastric sleeve) of their excess weight (excess weight = original wt minus IBW). To calculate your Body Mass Index click here.
Entered: Gregory F. Walton, MD, FACS – WeightWise