I have Cigna and they did cover my VSG. It's up to the COMPANY to choose if they will offer the coverage in their benefits package. I was with one company who didn't cover WLS or breast reduction then when the management changed - YEAH! WLS was covered 80/20 after a year of employment with the company and once you receive approval.
Today I'm sending the following letter off to the VP of HR and CC'ing the CEO. Hopefully you will never need to do anything similar, but in case you do, feel free to purger me. Enjoy!
Dear <VP of HR>:
My name is John and I have been with <my company> for a little over two years. I love working for <my company>. The people I work with are all second to none. We have a fantastic team here, and I wouldn’t trade it for anything. I’ve been married for 14 years and I have two boys, ages 7 and 9. I’m a Den Leader and Committee Member in my children’s Cub Scout Pack. Unfortunately, before the kids came along – in fact just after I married – I broke my foot and was in a cast for a long time – nearly 18 months. During that time, and the months that followed, I gained around 60 pounds, and have managed to slowly put on another 40 over the past 12 years. Now I’m what you would call Morbidly Obese. Worse, over the past 6 years I have also developed Type 2 Diabetes, Obstructive sleep Apnea and Gastroesophageal Reflux Disease (Acid Reflux). The diabetes and sleep apnea are serious conditions with potentially life threatening affects on the body. Besides the medical issues, it’s difficult to do things with my kids; it’s not fun staking a tent with 100 pounds of belly in your way.
My weight was floating at around 290 pounds, which at 5’11” tall put my BMI over 40. When I saw my doctor in the fall and knowing that my weight was the main reason for all of my medical issues, I asked if he thought I was a candidate for some form of Weight Loss Surgery. You see, I’ve been with him for a while, and he’s always advised me to go the way of “eat less, move more.” Not in so many words, but that’s a good summary. This time he considered the thought and said he would refer me to someone he knew.
I started down the road of research, attended a seminar, and following the seminar had a consultation with a bariatric surgeon. I was told that insurance had been verified, and since the first week of October, I have gone through all of the steps – and incurred the costs – needed to prepare for surgery. I’ve had an EGD and gallbladder ultrasound, a chest x-ray, a psychological evaluation and worked with a nutritionist for three months. I even lost about 25 pounds by the time all of my documentation was submitted to Cigna for approval, only to find that bariatric surgery of any kind is specifically excluded from my coverage.
When I confirmed this finding with HR, I asked why bariatric surgery is excluded, this was the answer I got: “We don't cover it due to the other complications that can arise from this particular surgery which in turn can cause higher claims.”
I have found it difficult to understand this policy. Research shows that bariatric surgery resolves – not just improves, but resolves – Type 2 Diabetes in 83% of cases, Sleep Apnea in 74-98% of cases, and GERD in 72-98% of cases. I would like to think that the decision to omit bariatric surgeries was made so many years ago and that the data has improved so much since then, if it were to be reconsidered and reevaluated today, <my company> might add this service to the benefits covered by the medical insurance offerings.
The information below will illustrate that there is a cost associated with NOT offering bariatric surgery as a treatment option. Diabetes alone costs <company name> and its employees an estimated $2.6 Million annually. I have spent many hours gathering this information, and I hope that you at least take the few minutes it will take to read through the information herein:
Obesity is one of the greatest public health and economic threats facing the United States. Approximately 72 million Americans are obese and, according to the American Society for Metabolic & Bariatric Surgery (ASMBS), about 18 million have morbid obesity (roughly 6% of the population). Obese individuals with a BMI greater than 30 have a 50 to 100 percent increased risk of premature death compared to healthy weight individuals as well as an increased risk of developing more than 40 obesity-related diseases and conditions including Type 2 diabetes, heart disease and cancer. The federal government estimated that in 2008, annual obesity-related health spending reached $147 billion, double what it was a decade ago, and projects spending to rise to $344 billion each year by 2018.
Co-morbidities associated with obesity:
The evidence is overwhelming on the association of obesity to a number of medical conditions. These include: insulin resistance, glucose intolerance, diabetes mellitus (specific statistics for this co-morbidity provided below), hypertension, dyslipidemia (high cholesterol), sleep apnea, arthritis, hyperuricemia (gout), gall bladder disease, and certain types of cancer. The independent association of obesity seems also clearly established for coronary artery disease, heart failure, cardiac arrhythmia, stroke, and menstrual irregularities. http://www.ncbi.nlm....pubmed/10593535
Diabetes Statistics:
Total: 25.8 million children and adults in the United States—8.3% of the population—have diabetes. <my company> having some 4,800 employees, statistically, 398 of them have diabetes.
New Cases: 1.9 million new cases of diabetes are diagnosed in people aged 20 years and older in 2010.
Morbidity and Mortality of Diabetes
575]· In 2007, diabetes was listed as the underlying cause on 71,382 death certificates and was listed as a contributing factor on an additional 160,022 death certificates. This means that diabetes contributed to a total of 231,404 deaths.
Complications of Diabetes
Heart disease and stroke
025]· In 2004, heart disease was noted on 68% of diabetes-related death certificates among people aged 65 years or older.
025]· In 2004, stroke was noted on 16% of diabetes-related death certificates among people aged 65 years or older.
025]· Adults with diabetes have heart disease death rates about 2 to 4 times higher than adults without diabetes.
025]· The risk for stroke is 2 to 4 times higher among people with diabetes.
High blood pressure
025]· In 2005-2008, of adults aged 20 years or older with self-reported diabetes, 67% had blood pressure greater than or equal to 140/90 mmHg or used prescription medications for hypertension.
Blindness
025]· Diabetes is the leading cause of new cases of blindness among adults aged 20–74 years.
025]· In 2005-2008, 4.2 million (28.5%) people with diabetes aged 40 years or older had diabetic retinopathy, and of these, almost 0.7 million (4.4% of those with diabetes) had advanced diabetic retinopathy that could lead to severe vision loss.
Kidney disease
025]· Diabetes is the leading cause of kidney failure, accounting for 44% of new cases in 2008.
025]· In 2008, 48,374 people with diabetes began treatment for end-stage kidney disease in the United States.
025]· In 2008, a total of 202,290 people with end-stage kidney disease due to diabetes were living on chronic dialysis or with a kidney transplant in the United States.
Nervous system disease (Neuropathy)
025]· About 60% to 70% of people with diabetes have mild to severe forms of nervous system damage.
Amputation
025]· More than 60% of nontraumatic lower-limb amputations occur in people with diabetes.
025]· In 2006, about 65,700 nontraumatic lower-limb amputations were performed in people with diabetes.
Cost of Diabetes
575]· $174 billion: Total costs of diagnosed diabetes in the United States in 2007. That’s $6744 per person who has diabetes per year. $2,684,186 for the 389 <my company> employees per year
575]· $116 billion for direct medical costs
575]· $58 billion for indirect costs (disability, work loss, premature mortality)
After adjusting for population age and sex differences, average medical expenditures among people with diagnosed diabetes were 2.3 times higher than what expenditures would be in the absence of diabetes.
Bariatric surgery is the only reliable treatment that offers sustained, long-term weight loss. This results in cure or improvement in almost all of the obesity-associated diseases and translates into reduction in the relative risk of death or increased longevity of the operated morbidly obese population. Since the treatment of obesity-associated conditions is very costly, bariatric surgery also results in significant reductions in healthcare costs with a return on investment of 3 years. It is not just weight loss, it is health gain. http://www.ncbi.nlm....pubmed/19440652
The treatment of obesity and related comorbidities are significant financial burdens and sources of resource expenditure. This study was conducted in order to assess the impact of weight-reduction surgery on health-related costs. Patients having undergone bariatric surgery had significant reductions in mean percent initial excess weight loss (67.1%, P <0.001) and in percent change in initial body mass index (34.6%, P <0.001). Bariatric surgery patients had higher total costs for hospitalizations (per 1,000 patients) in the first year following cohort inception (surgery cohort = CDN 12,461,938 dollars; control cohort = CDN 3,609,680 dollars). At 5 years after cohort inception, average cumulative costs for operated patients were CDN 19,516,667 dollars versus CDN 25,264,608 dollars, for an absolute difference of almost CDN 6,000,000 dollars per 1,000 patients. Conslusion: Weight-reduction surgery in morbidly obese patients produces effective weight loss and decreases long-term direct health-care costs. The initial costs of surgery can be amortized over 3.5 years. http://www.ncbi.nlm....pubmed/15329183
Bariatric Surgery As Treatment For Obesity And Therefore Other Co-Moridities
Metabolic/bariatric surgery has been shown to be the most effective and long lasting treatment for morbid obesity and many related conditions and results in significant weight loss. In the United States, about 200,000 adults have metabolic/bariatric surgery each year. The Agency for Healthcare Research and Quality (AHRQ) reported significant improvements in the safety of metabolic/bariatric surgery due in large part to improved laparoscopic techniques. The risk of death is about 0.1 percent and the overall likelihood of major complications is about 4 percent. The 30-day mortality rate for sleeve gastrectomy was 0.08 percent, while the rate for gastric bypass was 0.14 percent and 0.03 percent for gastric banding. These mortality and complication rates are lower than those typically associated with gallbladder or hip replacement surgery.
One study published in 2010 in the Journal of the Society of Laparoendoscopic Surgeons by the Surgeons Group of Baton Rouge, following the groups first 100 consecutive Laparoscopic Sleeve Gastrectomy, a relatively newer procedure included the following results: The percentage of excess body weight loss at the 3- and 6-month marks was 34.2% and 49.1%, respectively. Comorbidities were also improved at the 3- and 6-month marks. Hypertension resolved in 38%, hyperlipidemia resolved in 19%, and diabetes in 46%. Complication rate during the first 6 months was 10%. Major complications included 2 patients with postoperative bleeding, 2 patients with acute renal failure from dehydration, and 1 postoperative bleeding patient who developed a gastric fistula. No surgical reintervention was required for any complication. Conclusion: Our technique is a safe method that is easily reproducible and does not require any modification. Laparoscopic sleeve gastrectomy is an excellent surgical option with a low complication rate. http://www.ncbi.nlm....les/PMC3083039/
In the March 26, 2012 issue of the New England Journal of Medicine, Schauer et a published “Bariatric Surgery versus Intensive Medical Therapy in Obese Patients with Diabetes.” In this randomized controlled trial, the efficacy of intensive medical diabetes management alone versus laparoscopic Roux-en-Y gastric bypass or sleeve gastrectomy in 150 obese patients with uncontrolled type 2 diabetes was performed. The results were enlightening. In this specific population, the sleeve gastrectomy outcomes were equivalent to Roux-en-Y gastric bypass, a CMS covered surgical benefit. At the end of the one-year trial, hemoglobin A1C was 7.5 for intensive medical diabetes management, 6.4 for Roux-en-Y gastric bypass, and 6.6 for sleeve gastrectomy. As expected, weight loss outcomes had similar results namely, an end-point BMI (kg/m2) of 34.4 for intensive medical diabetes management, 26.8 for Roux-en-Y gastric bypass, and 27.2 for sleeve gastrectomy. Of note, when examining serious adverse events requiring hospitalizations, intensive medical diabetes management (non surgical treatment) and sleeve gastrectomy (bariatric surgery) hospitalizations were equivalent! (9 vs. 8 %, respectively). This trial was published in the New England Journal of Medicine, which leads all general medical journals in its impact factor. There is no question that this trial is of the highest methodological quality and should be part of the External Technology Assessment of the proposed decision memo.
In the April 16, 2012 issue of the Archives of Surgery, Leonetti and colleagues published Obesity, Type 2 Diabetes Mellitus, and Other Comorbidities: A Prospective Cohort Study of Laparoscopic Sleeve Gastrectomy (LSG) vs. Medical Treatment. From trial initiation to trial end at 18 months, the medical treatment control group gained weight (BMI, 39 to 39.8 kg/m2) and saw modest declines in Fasting Plasma Glucose (FPG) (183 to 150 mg/dL). In contradistinction, the LSG group saw substantial declines in both weight, BMI 41.3 to 28.3 kg/m2) and FPG (166 to 97 mg/dL) (note that 100-150 is considered “pre-diabetic,” and below 100 is “normal”). Cardiac risk factor assessment showed consistent superiority of Laparoscopic Sleeve Gastrectomy over medical therapy particularly for Triglycerides, mg/dl (LSG, 169 to 97; Medical, 199 to 173). http://asmbs.org/201...verage-decision
Since February 21, 2006, the Centers for Medicaid and Medicare Services (CMS) have covered Open and laparoscopic Roux-en-Y gastric bypass (RYGBP), open and laparoscopic Biliopancreatic Diversion with Duodenal Switch (BPD/DS), and laparoscopic adjustable gastric banding (LAGB) are covered for Medicare beneficiaries who have a body-mass index > 35, have at least one co-morbidity related to obesity, and have been previously unsuccessful with medical treatment for obesity. Also, effective June 27, 2012, Laparoscopic Sleeve Gastrectomy has been added to the list for National Coverage Determination (NCD) for Bariatric Surgery for Treatment of Morbid Obesity (100.1). http://alturl.com/wnbko
I urge you to consider adding bariatric surgery to the list of covered services to <my company> medical insurance offerings by leaving you to ponder the following: How many morbidly obese senior citizens do you know? How many do you even see? I’d be willing to bet the number is zero – I know that I don’t know any – because obesity has been proven to shorten a person’s life expectancy.
Sincerely,
My grandfather had most of his stomach removed many many years ago d/t a bleed... He's still kicking (healthy besides his unrelated COPD) at the young age of 91--- I swear he'll outlive us all.
I'm 8 months out and still suffer from serious Constipation. I've accepted it as a part of life. I tried many of the suggestions previously mentioned and they didn't work well for me. What did work is a tea that you can buy called "smooth move." I drink it every other evening before I go to bed and the issue is solved. It is frustrating because it certainly does affect the scales. It does get better though , I promise.
I wanted to keep it secret as a lot of people are very judgmental. However, I've gotten such great response from the people I have told that it's hard to contain myself. I want to tell it to the world, but for now those who don't know will remain in the dark.
My surgery was yesterday and it went great! Pain was minimal, and everyone at the hospital is awesome. Passed the leakage test today and get ice now. I've been up walking around without much assistance and feeling way better than I thought. Thanks to everyone on here for the support.
Anyone getting ready for their procedures, take an extension cord and Chapstick. The best things ever.
No shame, I think you did the right thing. This is a big freaking deal, a fact that not everyone seems to "get" but you do.
I think a younger person has at least a chance of losing weight without surgery (I couldn't but I believe it's possible)
If I couldn't do surgery, or had a regain after I would try:
1 intermittent fasting like 5:2
2 uber low carb
3 check into one of those behavior modification fat farms
I would combine any of the above with high intensity interval training (Google it)
I basically had to do the above (except the fat farm) post sleeve anyway to get to a normal BMI and maintain.
Best of luck to you and don't be down on yourself.
I've only told my family, my boss, and a few selected co-workers. Actually the co-workers that know only know because I had my EGD where I work. Other than that people will find out when they find out. I'm not ashamed to tell them I just don't feel that I have to. All the responses I've gotten have been very positive especially from people that I thought would try to talk me out of it.
I work at a gastroenterologists office where we perform EGD's and colonoscopies. The amount of money we bill out is no where near what we get paid. Unfortunately insurance plans are getting worse instead of better and the people that are suffering are the physicians and the patients. Insurances are covering less and less and most of the financial burden falls on the patient. It's actually quite disgusting. My office for example can't accept some of the Obamacare plans because we didn't participate in certain plans for a certain amount of time. Obamacare doesn't help the average Joe. It's horrible.
**** Please do not turn this into an anti band discussion. Everyone has been kind, respectful and civil so far, but this is not heading down a road BP supports.
We support ALL WLS procedures. It's an individual choice. @@Alex Brecher, the founder of this site, has had great success with the band. This is NOT a WLS debate.
If you have any concerns about my statement, please check our community guidelines. Thank you. ****
Reschedule it for 6 months out and take that time to think, get counseling, try to do it on your own, whatever you need. You will only fail yourself if you do something you are not ready for.
As for getting rid of something "God put there for a reason"? (No disrespect, just a quote.) If your appendix burst, you'd remove it. If your gall bladder went bad, you'd remove it. If your wisdom teeth came in, you'd remove them. I grew a freaking brain tumor the size of a lemon, I removed it. Well, my surgeon did.
If your heart was sick, you'd fix it. If your kidneys were failing, you'd fix it. Your stomach is failing you. Fix it.
I deal with insurances all day. You most definitely have the right to know what is going to be covered and what is not. If they are asking for cpt codes etc. you can get that from the surgeon's office. If you don't get anywhere with a regular rep demand to speak to their supervisor. Unfortunately, half of these reps don't really understand the information you are asking.
I deal with insurances all day. You most definitely have the right to know what is going to be covered and what is not. If they are asking for cpt codes etc. you can get that from the surgeon's office. If you don't get anywhere with a regular rep demand to speak to their supervisor. Unfortunately, half of these reps don't really understand the information you are asking.
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