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
- 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
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:
- Checking to see whether or not you qualify for the surgery
based on National Institute of Health guidelines
- Working with a doctor to provide the proper documentation
and convince the insurance company that surgery is medically
- 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.