In many cases, weight loss surgeries become necessary for patients. Dealing with obesity is tough, leading to various health problems. Moreover, obesity can get out of control. Many have gone for alternative weight loss programs and management with no luck. When conventional methods prove ineffective for losing weight, bariatric surgery can help you achieve sustained weight loss. This article aims to provide a comprehensive overview of accessing weight loss surgery through Medicaid, focusing on coverage, eligibility, and the process involved.
Understanding the Need for Weight Loss Surgery
Weight loss surgery, or bariatric surgery, can lead to significant weight loss and improve weight-related health conditions. Carrying excess weight for long periods of time can put you at risk for developing serious medical conditions, including heart disease, diabetes and cancer.
Bariatric surgery should be a last resort, after you attempt more conventional weight loss methods, such as regimented diet and exercise. However, we understand that surgery is absolutely necessary in certain situations.
Medicaid Coverage for Weight Loss Surgery
Weight loss surgeries can be costly and many people may not be able to afford it. The cost for bariatric surgery depends on the type of surgery, location of the surgery, and the patient. Medicaid does cover weight loss surgery in Texas, as long as the patient is eligible according to the criteria for coverage. Each state is individual in their Medicaid coverage, and you have to verify with Texas State to see what their coverage is. Weight loss surgeries are not extensively mentioned in the rules and guidelines for Medicaid coverage but are handled separately for different cases.
In most cases, Medicaid covers gastric bypass, gastric sleeve surgery, and Lap-Band Surgery. These are not only easily converted by Medicaid, but also among the most standard surgeries recommended. Generally, if the surgery is covered under Medicaid, there will be full coverage provided. If there is some part of the operation that is not under coverage, then you may have to look for other supplemental insurance or gap insurance to cover the surgery, once you are approved by Medicaid.
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Navigating the Approval Process
It is important for you to work with your physician to discuss the approval process for Medicaid coverage. If the Medicaid provided by Texas or any state you are from covers weight loss surgery, you should consult your physician. It is important to have a physician who can share vital information for the medical necessity of weight loss surgery for the patient. Further, a physician can also recommend the patient to approved surgeons.
After taking the decision, you have to go through certain tests and then consult the Medicaid office for the pre-approval of your surgery. The process can take some time and requires patience. Prior to approval, you may need to attend classes to gain knowledge about the surgery, lifestyle changes, exercise, nutritional needs, and so on. These are important for post-operative care. With all the necessary provisions, chances are you will get approval from Medicaid. These provisions can then include other additional classes or more testing.
After Medicaid approval, your surgeon has to determine if you are fit to undergo the procedure. This includes medical prep, X-rays, and blood tests. And then, finally, the surgery is booked. It can be difficult to determine what part of your surgery will be covered by Medicaid in your area. You can check the same with the local Medicaid office to see where this information can be available for you.
Types of Bariatric Procedures Offered
People with different body types and levels of overall health have different needs, so we offer multiple types of procedures to meet those needs.
- Gastric Banding (Lap Band Surgery): Gastric banding, or lap band surgery, is accomplished by placing a small device in your abdomen that wraps around the top of the stomach. We work with your individual physique to determine the optimal "tightness" of the device, to make you as comfortable as possible. By combining the physical effects of surgery with prolonged exercise and a commitment to eating smaller meals, you should be able to progressively lose weight and keep it off. Although it will increase the feeling of fullness, the band will not restrict you from eating larger meals, so maintaining your dedication to postoperative diet and exercise is critical for making this type of surgery a long-term success.
- Roux-en-Y Gastric Bypass: During the Roux-en-Y procedure, we create a small pouch at the top of your stomach. From there, the surgeon attaches a Y-shaped section of the small intestine to the pouch, allowing food to bypass the lower stomach. Gastric bypass is generally considered the procedure that enables the most weight loss within a time period of about two years. A minimally invasive metabolic procedure, gastric bypass diverts food to a surgically constructed pouch in the stomach, bypassing a section of the small intestine.
- Gastric Sleeve: Also known as a "sleeve gastrectomy procedure," this surgery limits the amount of food you can eat. We remove approximately 80% or more of your stomach, leaving behind a "sleeve" of stomach. A minimally invasive laparoscopic procedure, the gastric sleeve promotes weight loss by permanently removing two-thirds of the stomach. Gastric sleeve is considered an optimal treatment for metabolic syndrome. It is typically the best option if you are experiencing fewer or less severe health complications, have had other abdominal surgeries or have less than 130 pounds to lose. These minimally invasive procedures can be performed robotically or laparoscopically, removing approximately 75% of the stomach and bypassing a significant section of the small intestine.
The Importance of a Multidisciplinary Approach
While weight loss surgery is a powerful tool, lasting success requires a commitment to long-term changes. Healthy eating, regular activity and addressing any personal or social factors may all impact your progress. Each specialist on our team plays an important role in helping you achieve your long-term weight loss goals.
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Mental Health Support
We understand that surgery is just the beginning of your weight loss journey. Although losing weight after surgery may seem straightforward, there are other important considerations to address during the process. One of these considerations is your mental health. With weight loss surgery, you are experiencing a sizeable, albeit positive, lifestyle change that affects all aspects of your life, so getting behavioral support is key to long-term success. Recognizing this crucial role that mental health plays, our team makes all manner of support, guidance and resources available to you.
Finding Approved Surgeons and Facilities
At Nova Bariatrics, we have experienced approved bariatric surgeons Dr. Gulamhusein and Dr.. Approved surgeons help you understand the basics of the surgery and the various options at your disposal. UT Health physicians have performed bariatric surgery since the 1980s, making our highly experienced providers the providers of choice in San Antonio and South Texas. Houston Methodist’s board-certified bariatric surgeons have decades of experience and employ minimally invasive weight loss surgery techniques.
Houston Methodist hospitals are nationally accredited by the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP). Houston Methodist Center for Weight Loss & Bariatric Surgery provides the full range of bariatric surgery services, including extensive postoperative care designed to help each patient achieve lifelong weight loss success. That’s why we are dedicated to supporting you through routine follow-up care after surgery, nutrition resources and access to support groups with other patients of similar experience. At Las Palmas Del Sol Healthcare, our weight loss doctors support and guide you before and after surgery. We are equipped to skillfully perform a range of procedures designed to help you achieve long-term weight loss.
Addressing Costs and Financial Assistance
Not all insurance plans may cover the costs of weight loss surgery, but our team will work with your insurance provider to demonstrate the medical necessities of the procedure. During this process, you might need to provide documented evidence that you were unable to lose enough weight with a supervised diet and exercise program. Self-paying is another option to consider. Benefits of self-pay include avoiding waiting for your insurance provider to approve coverage for the procedure. As someone utilizing the self-pay option, you will receive a total upfront cost after your initial consultation.
Success Stories
Elena's journey to better health started with a visit to the bariatric team at Las Palmas Del Sol. Stacie experienced severe back and knee pain due to her weight.
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