Weight Loss (Bariatric) Surgery

Weight loss surgery is the beginning of a lifelong commitment to health. Dedication to proper diet, exercise and mental health is crucial to obtaining the best results. The surgery is a tool that improves the patient's ability to lose weight while following the recommended diet and exercise program as prescribed by our multidisciplinary team. The bariatric surgical programs at UnityPoint Health are comprehensive programs offering several important advantages for patients, including:

• A dedicated team of specialists who have many years' experience in caring for bariatric patients.
• Nutrition counseling to discuss the nutritional changes necessary for bariatric surgery.
• Exercise consultation will provide individual guidance about appropriate levels of exercise and intensity.
• Facilitation of quality care through immediate access to all areas of specialized physicians  
• Accessible, lifelong follow-up care.
• Follow-through with primary care physicians before and after surgery.

Bariatric Surgery: What to Expect

Weight loss surgery is a life-changing decision. The experienced team at UnityPoint Health wants to you to be fully aware of the commitments both before and after surgery that each of you will make. During your initial consultation, the surgery team will help you understand the comprehensive weight loss surgery program at UnityPoint Clinic Health. At the conclusion of the consultation, the team will determine if you are an appropriate candidate for weight loss surgery.

1. Be able to meet the qualifications for surgery by the time you have the procedure
2. Take an in-person seminar to prepare and educate you
3. Schedule with your weight loss provide
4. Meet with your team (surgeon, dietitian, insurance specialist, nurse practitioner)
5. Receive medical approval from your insurance company
6. Join a support group to prepare you for surgery
7. Take the required medical evaluations
8. Wait for your team's medical approval
9. Insurance approves surgery
10. UnityPoint Clinic - Weight Loss team will educate you on pre-surgical information
11. Undergo surgery
12. Maintain your follow-up care

Are You a Candidate for Bariatric Surgery?

To be considered as a candidate for surgery, most insurance providers require that certain criteria be met. The following is a list of qualifications which may apply to you:

• BMI greater than 40.
• BMI of 35 to 39.9 with one or more obesity-related diseases or problems, also known as co-morbid conditions.
• Documented efforts at weight-loss through a medically safe, well-balanced diet.
• Absence of other medical conditions that would make surgery unsafe.
• A willingness to lose weight and make changes in your eating habits and physical activity.
• Must be willing to stop frequent eating and drinking of high-calorie foods and beverages.
• You must be evaluated by a psychologist trained in bariatric psychology.
• You must be willing to increase physical activity and exercise as weight loss occurs.
• A commitment to yourself and your surgeon to keep regularly scheduled appointments.

Bariatric Surgery Follow-up Care

We feel that expert care is only available with this comprehensive team approach, and we are committed to providing weight loss surgery follow-up care in the safest manner possible. This means each patient will have a follow-up care schedule over the course of several weeks to months after their procedure. This could include:

• Dietary and Mental Health Counseling
• Exercise Consultation
• Reconstructive Surgery

Bariatric Surgery Insurance Coverage

Pre-Insurance Approval

Many insurance plans will cover weight loss surgery if you meet the National Institute of Health guidelines. It is your responsibility to contact your insurance company to be sure they will pay for the surgery. Some questions you should ask include:

• Is the surgeon in my insurance network?
• Is bariatric surgery covered under my policy?
• Are there special requirements, such as a physician-supervised diet and/or exercise program, that must be done before the surgery can be approved?
• The UnityPoint Health team will request approval from your insurance company and send copies of all your medical records. If you receive a denial from your insurance company due to a special requirement, please contact your primary care physician to help you meet that requirement.

Qualifying for Bariatric Surgery with Your Insurance Company

Before your consultation, you should contact your insurance company to make sure your plan covers weight loss surgery. Call the customer service number on your insurance card. Tell the customer service representative you are interested in bariatric surgery and ask if the service is covered by your plan. You may have to phrase this differently such as - morbid obesity surgery, weight loss surgery, or bariatric surgery. If they say the service is not covered or is excluded, this means your employer or whoever you get your insurance through, did not pay for this benefit. You may contact our office regarding cash payment options. Ask questions including:

• What will my co-insurance and deductible be for bariatric surgery?
• Is there an out-of-pocket maximum you pay for this procedure? Is there a lifetime maximum for weight loss surgery?
• If they say yes or tell you that it must be deemed "medically necessary". Ask the following questions:
  • What are your BMI requirements?
  • Do I have to have certain co-morbid conditions (medical conditions related to your weight?)? If so, what are the conditions?
  • Do you have a list of approved mental health providers?
  • Do I have to complete a physician-supervised diet, and for how long? Does the program need to include an exercise component?
  • Do I have to see a dietitian?
  • Do I need to complete a sleep study?
  • Do I need to obtain any cardiac testing?
  • Do I need any pulmonary testing (pulmonary function tests)?
  • Do I need to have certain blood work drawn?
  • Are there any other requirements?
  • Can you provide me with a checklist (the requirements for surgery)?

Physician-Supervised Diet - Information for Patients

Please be advised that every insurance plan is different. We strongly encourage patients to contact their insurance companies to see what is required for their pre-approval. Here are some general guidelines regarding a physician-supervised diet.

• What is a physician-supervised diet? A physician-supervised diet in its most basic form is when a patient meets with their family physician every month for a period of time to discuss their weight loss goals, an exercise plan, nutritional changes, and have their current weight and height documented. It is important that the physician thoroughly documents everything that is discussed at these visits in the patient's chart. Some insurance companies require patients to be on these diets for a certain period of time before surgery; others require patients to also meet with a dietitian or nutritionist. If this is a requirement of your insurance plan we can not submit your pre-approval until this diet is completed.
• I think that I have already completed a physician-supervised diet. How can I be sure? Contact your physician and ask if this diet was documented in your medical records. If it was and it was within the past three years, have those records sent to our office. Don't forget to contact your insurance company because their requirements may be different than what you have already completed.
• Is a letter from my physician good enough? Again, check with your insurance company to see what they require for insurance approval. Most insurance companies will require more than just a letter. Insurance companies want to see that the patient and the doctor met routinely in the office and most also want to track fluctuations in weight from each visit. It is nice, however, to have a letter of support from your family physician to send with your pre-approval.

Post-Insurance Approval

Support - Depending on your location, different support options may be available such as bariatric support groups - even for those whose bariatric surgery was not performed at UnityPoint Health and their families. We strongly recommend this support group to all of our patients as a great deal of information is exchanged by interacting with the other patients in the support group. You are not alone in your disease of morbid obesity and you will find that it is much easier to go through this life-changing surgery after talking with many others who have gone through the same thing.

Pre-Surgical Visit - After receiving approval from your insurance company, you will meet with our team for a final pre-surgery visit. At your pre-surgical visit you will:

• Schedule your bariatric surgery and have the opportunity to ask the surgeon any other questions you may have.
• Meet with our dietitian to discuss your eating habits and health history. The dietitian will also provide you with information on the importance of changing your diet before and after surgery.
• Be tested for H. Pylori, a bacteria that some people carry in their stomach. It can cause ulcers; you will be treated with antibiotics prior to surgery if it is present.

Bariatric Surgery - The procedure itself can take anywhere from one to three hours. Provided you have no complications, you can expect to stay in the hospital overnight for the gastric sleeve and the Lap-Band procedure. If you have a bypass you can expect to stay up to three days. Immediate care during and after weight loss surgery is provided by these and other specialists:

• Surgeon: weight loss surgeons have extensive experience with critical care patients and are able to provide comprehensive and complete care for any medical and surgical needs.
• Physician's Assistant: Our physician's assistant helps with all surgical cases and will help with your care while you are in the hospital.
• Anesthesiologists: board-certified anesthesiologists have extensive experience in the management of obese and overweight patients.
• Pulmonary specialists: Experts in sleep medicine work in conjunction with the surgeon and hospital staff to ensure patients with underlying respiratory problems, such as breathing disorders found in morbidly obese patients, have the best chance at optimal recovery.
• Cardiologists: board-certified cardiologists are available for any cardiac difficulties.

Surgical Follow-Up Visits - After surgery, you will have scheduled visits with the surgeon and other members of the weight loss surgery team. During these visits, weight loss, diet and physical activity will be reviewed. Examinations and tests will be performed as needed. Our goal is to provide continued care and encouragement. Follow-up is extremely important to every bariatric surgery patient. Although some of the tools for weight reduction will have been provided, learning to use these tools properly is not easy. Patients must make attitude and habit changes related to eating, coping with stress and pleasure-seeking in order to ensure hunger is controlled and overeating or frequent snacking does not occur.