How effective is surgery?
The actual weight a patient will lose after the procedure is dependent on several factors. These include:
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Patient's age
- Weight before surgery
- Overall condition of patient's health
- Surgical procedure
- Ability to exercise
- Commitment to maintaining dietary guidelines and other follow-up care
- Motivation of patient and cooperation of their family, friends and associates
In general, weight loss surgery success is defined as achieving loss of 50% or more of excess body weight and maintaining that level for at least five years. Clinical data will vary for each of the different procedures mentioned on this site. Results may also vary by surgeon. Ask your doctor for the clinical data stating their results of the procedure they are recommending.
Clinical studies show that, following surgery, most patients lose weight rapidly and continue to do so until 18 to 24 months after the procedure. Patients may lose 30 to 50% of their excess weight in the first six months and 77% of excess weight as early as 12 months after surgery. Another study showed that patients can maintain a 50-60% loss of excess weight 10-14 years after surgery.
Patients with higher initial BMIs tend to lose more total weight. Patients with lower initial BMIs will lose a greater percentage of their excess weight and will more likely come closer to their ideal body weight.
Patients with Type 2 Diabetes tend to show less overall excess weight loss than patients without Type 2 Diabetes.
The surgery has been found to be effective in improving and controlling many obesity-related health conditions. A 2000 study of 500 patients showed that 96% of certain associated health conditions studied (back pain, sleep apnea, high blood pressure, diabetes and depression) were improved or resolved. For example, many patients with Type 2 Diabetes, while showing less overall excess weight loss, have demonstrated excellent resolution of their diabetic condition, to the point of having little or no need for continuing medication.
Insurance issues
Why does it take so long to get weight loss surgery insurance approval?
After your telephone interview consultation is completed, it usually takes your doctor 1-2 days to send a letter to your insurance carrier to start the approval process. The time it takes to get an answer can vary from about 3-4 weeks or longer if you are not persistent in your follow-up. Most treatment centers have insurance analysts who will follow up regularly on approval requests. It may be helpful for you to call the claims service of your insurance company about a week after your letter is submitted and ask about the status of your request.
How can they deny insurance for a life-threatening disease?
Payment may be denied because there may be a specific exclusion in your policy for obesity surgery or "treatment of obesity." Such an exclusion can often be appealed when the surgical treatment is recommended by your surgeon or referring physician as the best therapy to relieve life-threatening obesity-related health conditions, which usually are covered.
Insurance payment may also be denied for lack of "medical necessity." A therapy is deemed to be medically necessary when it is needed to treat a serious or life-threatening condition. In the case of morbid obesity, alternative treatments - such as dieting, exercise, behavior modification, and some medications - are considered to be available. Medical necessity denials usually hinge on the insurance company's request for some form of documentation, such as 1 to 5 years of physician-supervised dieting or a psychiatric evaluation, illustrating that you have tried unsuccessfully to lose weight by other methods.
What can I do to help the insurance approval process?
Gather all the information (diet records, medical records, medical tests) your insurance company may require. This reduces the likelihood of a denial for failure to provide "necessary" information. Letters from your personal physician and consultants attesting to the "medical necessity" of treatment are particularly valuable. When several physicians report the same findings, it may confirm a medical necessity for surgery.
When the letter is submitted, call your carrier regularly to ask about the status of your request. Your employer or human relations/personnel office may also be able to help you work through unreasonable delays.