At Dr Balder’s specialty center for minimally invasive Weight Loss Surgery, we are committed to performing weight loss procedures that enable our patients to experience healthier, longer lives. We are also dedicated to educating our patients so that they have the information they need to proceed with bariatric surgery and make the necessary lifestyle changes that are required to succeed in a healthier new life.
We provide detailed information to assist the educational process which is of the upmost important.
For further additional information, please contact our laparoscopic weight loss surgery practice.
Below are some of the most frequently asked questions patients have about bariatric surgery. If you have any other questions, or would like to schedule an appointment, we would love to hear from you.
Q: What is morbid obesity?
A: Obesity results from having an abnormally high proportion of body fat which exceeds the body’s skeletal and physical standards. Obesity develops into morbid obesity when an individual is 100 pounds or more over their ideal bodyweight and has a BMI (Body Mass Index) of 40 or higher. Morbid obesity affects an estimated 10 million Americans; a number that has nearly doubled in the last 30 years. Morbid obesity includes one or more serious health conditions or diseases that are a direct result of the excess weight an individual is carrying. These are known as co-morbidities. Co-morbidities result in an individual experiencing some type of significant physical ailment, which in some cases can lead to death. With over 10 million sufferers today, morbid obesity is becoming more than just a serious disease, it’s a national epidemic.
Let our bariatric team help you overcome your battle with obesity! Remember, you do have options. We want to see you succeed on your weight loss journey.
Q: Are you a candidate for weight loss surgery?
A: With over 6 million Americans suffering from morbid obesity, the need for weight loss surgery has become more apparent. Morbid obesity brings with it a plethora of health issues that if left untreated will substantially shorten life expectancy. In fact, morbidly obese adults (those individuals whose weight is twice the ideal amount) are twice as likely to have an early death as compared to a non-obese adult.
Would you like to know if you are a candidate for weight loss surgery? To determine if you are a candidate for surgery, it’s important to know what medically classifies an individual as “morbidly obese”. The following criteria are characteristic of a morbidly obese individual and could qualify you for weight loss surgery:
100 pounds or more over their ideal body weight.
BMI (Body Mass Index) of over 40.
A BMI of 35-40 accompanied by significant life threatening medical conditions such as Type II diabetes, high blood pressure, heart disease, and severe sleep apnea.
Inability to maintain a healthy body weight for a sustained period of time after numerous attempts to achieve weight loss with diet, exercise, medication, hypnosis, therapy, or a combination of methods.
Overweight for at least 5 years with many failed attempts at losing the excess weight.
Weight loss surgery is often the only option for an obese individual to improve their health. In fact for many patients, the risk of death from not having weight loss surgery is much greater than the potential risks associated with the procedure itself. It’s important that you discuss all of your concerns with our bariatric team. Remember, we’re in this with you, every step of the way.
Please Note: It’s important to remember that weight loss surgery is not the answer for everyone who suffers from obesity. The operation is an elective procedure so it’s imperative that you are well informed on the potential risks and benefits involved. Also, the surgery is not a guarantee to produce and maintain long term weight loss. It’s only the beginning of a lifelong commitment to healthy living that is required if you are to succeed. Following the operation, you will begin the process of making important lifestyle and behavior changes in order to increase your chances of experiencing lasting weight loss and continued good health.
Q: What insurance carriers generally cover weight loss surgery and how long is the "wait"?
A: Tricare, Humana (and some random BCBS) generally have a short wait until qualified for weight loss surgery.
BCBS policies vary, and most (who do not exclude weight loss surgery) have a 3-6 month pre op requirement.
Cigna/Aetna and M'Care generally have a least a 4 month pre-op requirement.
Fox Everett has a 6 month pre op requirement.
Some insurance companies may have a "fast track" which can allow some patients to proceed quicker with pre-op requirements - so please discuss your needs with out team!!
REMEMBER, THAT EVEN IF THE REQUIREMENT IS A 6MONTH WAIT, IT STARTS WHEN WE SEE YOU AND THE TIME FLYS BY....WITHOUT STARTING THE PROCESS, INSURANCE WILL NOT COVER, SO WHY WAIT?
Q: Is bariatric surgery safe?
A: A surgical procedure of any kind will always involve a certain degree of risk, and bariatric surgery is no exception. In the past, weight loss surgery was viewed as extremely risky. However, with the development of new procedures and advancements in technology (especially laparoscopic procedures), bariatric surgery is a relatively safe solution to morbid obesity. Today, the overall risk of weight loss surgery is fairly low with most patients experiencing few, if any, complications. This is not to minimize the fact that this is still a serious operation, which should only be considered after all other weight loss options have been exhausted.
There is a national data bank which follows weight loss surgery procedures and their complications. All of these possible "bad outcomes" are always discussed and detailed with each and every patient before any surgery is scheduled.
Once a surgeon has determined that you are a candidate for weight loss surgery, it’s very important that as a patient you reveal all pertinent medical information to your surgical team. The bariatric surgeon will assess the risks involved with your particular surgery and take every precaution necessary to ensure your safety and to reduce the risk of complications.
Regardless of the type of weight loss surgery, it’s important that the decision to undergo surgery is carefully thought out. It’s imperative to weigh the risks of surgery with the long-term risks of remaining obese. Discuss any concerns you might have with your surgical team and your outside support system (family, friends).
Q: Does bariatric surgery work?
A: All surgical procedures, whether bariatric or otherwise, have some level of risk. Each laparoscopic weight loss surgery procedure that we offer has different benefits and risks that are associated with each individual procedure and the underlying health of each patient. Dr Balder and our staff will make sure that you are fully informed of these benefits and risks. We are one of the few laparoscopic weight loss surgery “Centers of Excellence, ” on the Gulf Coast - Dr Balder has established national recognition because of his effective results and low complication rates.
Please remember that typically, there are associated dangers of living with the chronic disease of obesity; and these likely hold greater risk than surgery itself. Morbid obesity, when left unchecked, will shorten one's life as well as diminish the quality of one's life.
Q: What kind of lifestyle changes will I have to make following surgery?
A: Aside from the most obvious change that takes place with respect to diet, there are a number of other lifestyle changes that have to occur in order to experience success on your weight loss journey.
Avoid alcoholic beverages.
Avoid high fat, high fiber foods.
Chew slowly during meals.
Don’t drink with meals (it makes you feel full too fast).
Keep snacking between meals to a minimum.
Omit desserts and sugary foods.
Your post surgery physical activity level will likely be determined by the type of procedure you have undergone. Most patients can return to work within 1-3 weeks following laparoscopic surgery, while open surgical procedures may be slightly longer. Exercise can typically resume within six weeks or less after surgery.
Long term follow-up care will be required annually and sometimes more frequently depending on post-surgical body functions. There will be frequent testing to determine:
Nutritional levels (vitamin B-12, iron, and folate levels, etc.).
Is the patient anemic (i.e., low red blood cell count).
Having the support of family and friends is important; however, equally important is for a person to surround themselves with other weight loss surgery patients who understand the intricacies of weight loss surgery. Weight loss surgery is not a quick fix to repair the years of emotional pain caused by being morbidly obese. The support groups are merely a way for patients to share their challenges and/or success’ with others who have been through similar challenges. In fact, there is typically a big difference between the patients who are involved in a support group on a regular basis and those who attempt their weight loss journey alone. Our surgical team will provide you with a list of support groups to fit your needs.
For the first 18-24 months after weight loss surgery it’s important that women of childbearing age do not conceive. Pregnancy can be taxing on the body and the potential for fetal damage increases. During this waiting period, it’s important to give the body time to heal and recuperate. For this reason, a surgeon will typically advise you to take every precaution necessary to reduce the chances of becoming pregnant.
Q: Does insurance cover weight loss surgery?
A: Having health insurance does not guarantee you will be covered for weight loss surgery. Since the cost of this procedure can be very expensive, most patients would not even consider it an option if it were not for insurance or low interest financing. Although weight loss surgery is still considered an elective procedure, it may be covered by your insurance carrier. For this reason, it’s important that you fully understand what “is” and “is not” covered by your insurance provider.
Before you attempt to get authorization, here are some helpful hints to assist you with the authorization process:
- Read and understand your insurance provider’s "certificate of coverage."
- Get a referral and copy of medical records from your primary care physician in order to substantiate your claim.
- Keep accurate, detailed records of visits to healthcare providers. Also, save receipts for any exercise equipment, fitness programs, diet centers, weight loss drugs and anything else that can assist in the authorization process.
With so many different insurance policies and types of plans among insurance providers, it’s important that you understand the authorization requirements for your individual policy.
The insurance company will typically ask for the following information and documentation (Be prepared to provide these upon request):
- Current weight, height, and BMI.
- Verification from a physician that the patient is 100 lbs or more over their ideal body weight.
- The surgery recommended along with any post operative follow-up care, including nutritional and psychological support.
- A detailed medical history including co-morbidities (i.e., the presence of one or more diseases in addition to a primary disease).
- Six (6) months of medical records including a patient evaluation, treatments performed to date, and specific types of lab work done.
- Six (6) months of a documented dieting and exercise routine (must include dates and results).
- A psychological/psychiatric evaluation.
Once you have submitted your claim it’s a simple matter of waiting for your insurance provider to respond. At times it can be a frustrating and discouraging process, but don’t give up. If your claim is denied you have the right to appeal the decision. Being denied coverage for surgery happens to many patients and this initial set back does not mean that you’ve reached the end of the road. Some insurance providers may initially deny bariatric surgery claims automatically the first time they’re submitted, and can be more receptive to follow-up appeal letters.
If you have questions about the insurance process, please don’t hesitate to contact our office. Let our experienced bariatric team help you with the authorization process.
Q: Will my insurance cover the procedure?
A: It depends on your employer and the plan you have chosen. The plan your employer chooses will dictate if this procedure is a covered benefit when medically necessary or if this procedure is excluded on your particular policy. We know that many patients are worried about paying for their treatment and that these financial concerns can add stress to their lives as they plan for weight loss surgery. We are committed to providing convenient and affordable financing options or alternatives for your assistance through the process. We will also personally work to help you obtain approval from your insurance company (if it is a covered benefit under your current plan). Our insurance experts, through the years have enabled many of our patients to receive treatment who otherwise would not have been able to. Contact our laparoscopic weight loss surgery center for more information about financing.
Q: How can I find out if my policy covers the surgery?
A. Call the customer service number on the back side of your insurance card and ask them if gastric sleeve, gastric bypass surgery or adjustable gastric banding is a covered benefit if medically necessary. In discussion with your insurance company, you may need to talk some “jargon” with numbers.
The diagnosis code or ICD-10 is E66.01.
The laparoscopic gastric sleeve code is 43775.
The laparoscopic gastric bypass procedure code is 43644
The adjustable gastric banding procedure code is 43770.
The revisional surgery codes include 43860.
Q: What are the routine tests before surgery?
1. All patients must undergo a psychological evaluation prior to undergoing elective weight loss surgery.
2. Baseline blood work includes: complete blood count, complete metabolic panel, TSH.
3. PRE OP Chest X-ray and an electrocardiogram (EKG). If these tests have been recently done by your primary care doctor, please bring them with you to your consultation, and we may not have to repeat them.
4. In addition to the routine lab work and tests, some patients may need additional studies such as:
Ultrasound of Liver
Barium UGI (these evaluate your anatomy & your swallowing mechanics)
Pulmonary Function studies for Hx significant pulmonary disease
Possibly an Upper Endoscopy (EGD)
If EKG is abnormal or SOB is significant - and Echocardiogram, or Stress Test may be needed for cardiac clearance.
Q: Can I start the process before I schedule my appointment with Dr. Balder?
A: Yes, you can complete the new patient history information packet and start collecting the following documentation:
1. Five-year weight history from your primary care physician (PCP), or GYN, or other.
2. Physician office notes that document a physician’s supervised weight loss program to include low calorie diet with evaluation by a dietician, increased physical activity plan, behavior modifications, and monthly weights. Each insurance company has different requirements for the length of this program –usually three to six months. We cannot change what a person’s individual policy requires.
3. Letter of medical necessity from your primary care physician is always helpful. A sample letter to assist in writing the letter is provided as a word document - Sample Letter of Medical Necessity.
4. Recent lab work or studies that document your comorbidities (high blood pressure, diabetes, sleep apnea).
Q: How do I start living my life again?
A: We look forward to meeting you and helping you start on the pathway to a new healthy life and lifestyle!
We offer new patient consultations daily, and will publish our MIWLS seminars starting in January 2018.
Please contact our laparoscopic weight loss center to schedule your appointment, at your earliest convenience.