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Medicare Bariatric Surgery For Weight Loss

Medicare coverage for bariatric weight loss
06/20/2022
  • Medicare with Melissa

The good news for Medicare beneficiaries is that there are several Medicare bariatric surgery options for weight loss. In fact, according to the Centers for Medicare & Medicaid Services (CMS), Medicare covers four types of bariatric surgeries: Gastric Bypass, Sleeve Gastrectomy, Duodenal Switch and Lap-Band Surgery.

Obesity is a growing problem in the United States. According to the National Institutes of Health, more than one-third of Americans are obese. Obesity increases your risk for many health problems, including diabetes, heart disease, and stroke. Losing weight can help reduce your risk for these diseases.

There are many ways to lose weight, but not all methods are healthy or sustainable. Some fad diets promise quick results but may be unhealthy or even dangerous. Another option is bariatric weight loss surgery, which is very effective both in the short term and long term.

If you think you may be eligible for coverage, talk to your doctor about whether bariatric surgery is right for you. Your doctor can help you understand the risks and benefits of the procedure and determine if you meet the criteria set forth by Medicare.

What Is bariatric surgery?

Bariatric surgery is an alternative option for weight loss. Gastric bypass, lap-band, sleeve and duodenal are fall under considered bariatric surgery options.

The process includes surgical procedures on the stomach or intestines to induce weight loss. Bariatric surgery includes a variety of procedures performed on people who are obese.

Long term weight loss through the standard of care procedures is possible by altering gut hormone levels.

Most common types of weight loss surgery?

There are 4 common types of bariatric weight loss procedures.

  • Gastric Bypass
  • Sleeve Gastrectomy
  • Duodenal Switch
  • Lap-Band Surgery

Gastric Bypass Surgery

Gastric bypass is one kind of bariatric procedures. During the gastric surgery, the top of the stomach turns into a small gastric pouch.

The surgeon cuts a loop of the small intestine and one end of the loop fed up and connected to the gastric pouch. This connection is one anastomosis. The other end of the small intestine loop reconnects to the small intestine, further down. This is another anastomosis.

Food is then redirected to an area farther down in your digestive system. It bypasses the stomach. Because food will now bypass your stomach, your body does not absorb as many calories. You will feel full much faster after eating.

Sleeve Gastrectomy

Sleeve gastrectomy is also known as vertical sleeve gastrectomy.

This procedure is typically performed laparoscopically, which involves inserting small instruments through multiple small incisions in the upper abdomen.

During sleeve gastrectomy, about 80% of the stomach is removed, leaving a tube-shaped stomach about the size and shape of a banana.

Limiting the size of your stomach restricts the amount of food you are able to consume. In addition, the procedure prompts hormonal changes that assist with weight loss. These same hormonal changes also help relieve conditions associated with being overweight, such as high blood pressure or heart disease.

Duodenal Switch

The duodenal combines a sleeve gastrectomy with an intestinal bypass. The duodenal switch is the most complicated but also the most effective bariatric surgery. It’s especially effective against Type 2 diabetes.

By removing part of your stomach, this restricts how much food your stomach can hold, and how much nutrition your small intestine can absorb from your food. (This makes it a “malabsorptive” procedure). It also reduces the hunger hormones that your stomach and small intestine normally produce.

There are currently two different forms of the duodenal switch in practice. The original is called the biliopancreatic diversion with a duodenal switch (or sometimes, the gastric reduction duodenal switch). This is the version with the most history and research behind it. The newer version, the loop duodenal switch, was developed to simplify the procedure and reduce complications.

Lap-Band Surgery

Lap-Band surgery, or laparoscopic adjustable gastric band surgery, is one of the least invasive surgical options available for obesity. Adjustable gastric banding is a purely restrictive procedure that involves placing a band around the uppermost portion of the stomach.

Why is weight loss surgery recommended?

Bariatric surgery is done to help you lose excess weight and reduce your risk of potentially life-threatening weight-related health problems, including:

  • Heart disease and stroke
  • High blood pressure
  • Nonalcoholic fatty liver disease (NAFLD) or nonalcoholic steatohepatitis (NASH)
  • Sleep apnea
  • Type 2 diabetes

Requirement for weight loss surgery

To be eligible for weight-loss surgery, you must meet the following criteria:

  • Have a body mass index (BMI) of 40 or higher, or
  • Have a BMI between 35 and 40 and an obesity-related condition, such as heart disease, diabetes, high blood pressure or severe sleep apnea.

Does Medicare Cover Bariatric Surgery?

Medicare covers some bariatric surgical procedures, like gastric bypass surgery and laparoscopic banding surgery, when you meet certain conditions related to morbid obesity.

Be sure to talk with your physician about approved Medicare weight loss treatments as this coverage can very on a case-by-case basis. Bariatric surgeries are generally billed under Medicare Part B, as this is an outpatient procedure.

Remember, not all Medicare plans are the same. Medicare Supplement Plans work together with Original Medicare Part A and Part B. The most popular plans are Plan F, Plan G and Plan N.

If you have a Medicare Advantage Plan, cost can very from plan to plan. Medicare Advantage Plans (Part C) can also have a network of physicians. Be sure that your doctor accepts the plan you have and discuss cost prior to the procedure.

Can you gain weight back after bariatric surgery?

It is very possible to gain weight back after bariatric surgery. Studies show that on average, people can start gaining weight 12-18 months after the procedure. Reasons why someone gains weight back will vary on lifestyle and efficiency of the surgery.

What are the most common risks and side effects of bariatric surgery?

  • Acid reflux.
  • Anesthesia-related risks.
  • Chronic nausea and vomiting.
  • Dilation of esophagus.
  • Inability to eat certain foods.
  • Infection.
  • Obstruction of stomach.
  • Weight gain or failure to lose weight.

Other complications include:

  • Bowel obstruction.
  • Dumping syndrome, causing diarrhea, nausea or vomiting.
  • Gallstones.
  • Hernias.
  • Low blood sugar (hypoglycemia)
  • Malnutrition.
  • Stomach perforation.
  • Ulcers.

Benefits of gastric bypass surgery

Gastric bypass is done to help you lose excess weight and reduce your risk of potentially life-threatening weight-related health problems, including:

  • Gastroesophageal reflux disease
  • Heart disease
  • High blood pressure
  • High cholesterol
  • Obstructive sleep apnea
  • Type 2 diabetes
  • Stroke
  • Cancer
  • Infertility

Which is better gastric bypass or duodenal switch?

For most, the duodenal switch has the best results compared to the gastric bypass and the gastric sleeve. On average, patients who have the duodenal switch can expect to lose 80 to 100% of their excess weight.

What is better gastric bypass or gastric sleeve?

That depends. The Gastric Bypass carries more risk but has more rewards for patients who need to lose 150 plus pounds.

Whereas the Gastric Sleeve surgery has a lower complication rate. But the patients who have success need to lose 100 or fewer pounds with the gastric sleeve.

What’s better gastric band or sleeve?

Those who undergo gastric sleeve surgery tend to lose weight more quickly than those with gastric bands.

Expect to lose between 60 and 70 per cent of their excess body weight within 12 to 18 months.

What is Candy Cane syndrome?

Abstract. Candy cane syndrome is a rare complication reported in bariatric patients following Roux-en-Y gastric bypass. It occurs when there is an excessive length of roux limb proximal to gastrojejunostomy, creating the possibility for food particles to lodge and remain in the blind redundant limb.

Getting help with Medicare coverage for bariatric surgery is easy!

Our friendly team of licensed insurance agents can help you determine if the Medicare coverage you have will help cover the cost of your weight loss procedure.

If you have a plan with limitations, we will provide alternative coverage solutions.

Call 866-633-4427 to speak with an agent today!

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Medicare is not simple and can be hard, frustrating, and downright confusing for most. I love when I get someone on the phone and I am given the opportunity to explain the difference in plans to them and have Medicare make sense. I enjoy talking to clients year after year, hearing about their families growing or them asking about mine.

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