The Skinny on Gastric
Bypass & Insurance

by Penny M. Hagerman

For the grossly obese, losing weight and overcoming a myriad of health problems can be quite challenging. But a surgical option known as gastric bypass has become increasingly available in recent years, giving patients a new lease on life—and the opportunity to live healthy and thin.

The Surgical Approach

One of the most popular weight-loss options for those with a body mass index of 40 or more, gastric bypass—or bariatric surgery, as it's also called—typically results in quick, impressive weight loss and increased overall health, including:

• Mortality rate reduced by up to 89 percent in the first five years following surgery
• Hypertension relieved in over 70 percent of patients
• Reversal of type two diabetes in up to 90 percent of adults and teens
• Marked reduction in occurrence of sleep apnea
• Relief from esophageal reflux
• Reduction in tissue swelling due to excess weight
• Relief of lower back and joint pain that accompanies obesity

During gastric bypass, the surgeon divides the stomach into a small upper pouch (the new stomach) and a much larger, lower pouch (the original stomach). He then rearranges the small intestine, effectively "bypassing" the larger stomach, and attaches both pouches to it.

The smaller pouch becomes the repository for food and the larger one is used only to produce the chemicals needed for digestion. This severely restricts the volume of food the patient can eat and helps digestion occur more quickly.

Paying the Price

Though the cost associated with major, life-altering surgery like gastric bypass precludes some people from taking advantage of its benefits—especially when forced to pay out of pocket—the reduced number of medical insurance claims that results has led many insurance companies to begin covering these life-changing procedures.

At an average of $25,000 to $35,000 per operation, that's good news to the seriously obese, who appreciate the chance to shed the excess weight and regain control of their lives.

While some insurers cover the surgery 100 percent, others pay only 50 percent, leaving co-pays and coinsurance up to the policyholder. A few insurance companies have yet to add the procedure to their list of covered benefits, but should soon be moving that direction because of the reduction in health insurance claims that result.

Getting Cleared for Surgery

For anyone interested in gastric bypass, the first step is checking with your insurance provider to find out whether the procedure is covered under your individual or employer-paid health plan. Details like these may be listed in the section of your policy called "covered benefits," or may be determined by calling your insurer and asking about weight loss surgery coverage.

From there, it's simply a matter of:

1. Checking to see whether or not you qualify for the surgery based on National Institute of Health guidelines
2. Working with a doctor to provide the proper documentation and convince the insurance company that surgery is medically necessary
3. Undergoing pre-op tests to eliminate the presence of complicating health factors and get cleared for surgery

Your doctor can help you with the preparatory work and help arrange the tests you need in order to proceed.

A New Life

Some say taking the surgical route to a healthy life is "cheating." But those who've experienced it couldn't disagree more.

Indeed, life after gastric bypass can be both rewarding and fulfilling. And, as more and more insurance companies jump on the bandwagon to offer policyholders coverage, our nation's health statistics will only improve, as more and more people choose the surgical route to a more healthy, productive life.