Does Medicare Cover a Gastric Bypass Revision?

Gastric bypass is a form of bariatric surgery that has a strong track record of helping patients lose weight and keep it off long term. With that said, sometimes, it doesn’t take the first time, or there are other issues that require a revision. If you have Medicare coverage and might require revision, it is important that you understand what your benefits will cover. Revision bariatric surgery insurance coverage can vary.

Weight Gain After Bypass

After getting a Roux-en-Y in Maryland, you should experience weight loss that will speed up, slow down, and plateau at various times until you reach your ideal weight—assuming you are maintaining a proper diet and exercise routine. However, the occasional patient will only experience initial weight loss, then begin gaining again. An even smaller percentage never lose weight at all. When a patient gains weight after gastric bypass surgery, it is important that their doctor ascertains the reason this is occurring. This will not only determine what the next steps are, but also might impact whether or not Medicare will pay for gastric bypass revision.

Potential Causes of Post-Bypass Weight Gain

  • Enlarged Stoma: This is the opening between the stomach and the intestines. Gastric bypass not only creates a smaller stomach, but should also make the stoma smaller, making it harder for food to pass through.
  • Too Much Absorption: Another aspect to the function of a bypass is malabsorption of calories. If this is not sufficient, you will continue to take in excessive calories and gain weight.
  • Large Pouch: If your stomach pouch isn’t made small enough, it will be able to accommodate too much food, allowing food to be stored for longer and the calories absorbed.
  • Gastro Fistula: With this, a fissure develops that allows the stomach and intestine to connect outside of the surgical bypass.
  • Poor Lifestyle: Out of all the options, this is the most common. If you do not eat healthier, portion control, and exercise regularly, you will gain weight.

Does Medicare Pay for Gastric Bypass Revision?

Generally speaking, Medicare does cover gastric bypass revision when it is deemed medically necessary. However, this requires documentation supporting surgery as the solution. If your weight gain is related to a poor lifestyle, you are more likely to have coverage of bariatric revision surgery in Baltimore denied. Medicare typically will require you to seek behavioral health services to modify your behaviors and make better choices instead of covering revision, or at least mandating this as a step to getting coverage. If you are considering gastric bypass or revision surgery, work with the top-rated bariatric surgeons in Maryland. Call Maryland Bariatrics to schedule your consultation.

How Much Weight Will I Lose After Gastric Bypass?

Bariatric surgery is used by thousands of Americans to lose large amounts of weight very quickly with the intent of keeping it off for good. Surgery has shown to be more effective than diet and exercise alone in helping obese patients lose weight. If you’re like some patients, you want to know how much weight you can lose with gastric bypass surgery. In this article, you’ll learn about the expected weight loss after gastric bypass and why some people plateau after surgery.

How Gastric Bypass Works

Gastric bypass surgery, otherwise known as roux-en-Y gastric bypass (RYGB), is a surgery developed in the mid 20th century by doctors looking for a cure for obesity. What they discovered, although not a cure, was an effective surgical treatment for chronic obesity if the patient sticks to instructions. The way gastric bypass surgery works is by taking a part of the stomach and creating a small pouch with it, which limits the amount of food that a patient can consume in one sitting. Then, the surgeon connects the stomach to a lower part of the small intestine, reducing the amount of food that can be digested and absorbed by the body. In total, the patient is less able to consume large amounts of foods and they end up getting fewer calories from the food they do consume. As a result, patients consume much fewer calories than they burn, causing rapid weight loss.

Expected Weight Loss After Gastric Bypass

Gastric bypass patients can expect to lose between 50% and 60% of their excess weight in one year after surgery. Your excess weight is calculated by subtracting your goal weight from your current weight. A patient who weighs 400 pounds and has a goal weight of 200 pounds can expect to lose between 100 and 120 pounds in the first year. How much weight you lose the first month after gastric bypass will depend on the weight you started at, but the first month is where patients see the most weight loss. Weight loss then slows down and is expected to stop between 18 and 36 months after getting surgery. Some patients see weight loss plateaus even earlier. But why do they plateau, or worse, see weight gain?

Why Some People See Weight Loss Plateaus

Old Habits Die Hard

Obese patients seeking bariatric surgery are likely to be dealing with food addiction. Or, they engage in other maladaptive eating behaviors such as binge eating. These behaviors, when done frequently over time, can turn into habits and these habits die hard. Patients are advised to seek mental health counseling before and after surgery to make sure that they’re prepared to handle getting rid of harmful eating behaviors altogether, with the help of bariatric surgery.

Lack of exercise

Many patients look at the surgery and see it as a way to lose weight without having to exercise. Although patients don’t have to exercise to lose weight with gastric bypass surgery, exercise has been shown to help bariatric surgery patients lose more weight. Exercising not only can help a patient lose more weight, but it can serve as an excellent replacement behavior for some maladaptive eating behaviors. It’s also excellent for adding additional muscle mass, which can help the patient lose more fat and fill in loose skin.

Some patients need revision surgery

Although many patients plateau because they fall into old, unhealthy behaviors, some patients end up dissatisfied with the efficacy of the surgery. This is because some patients need bariatric revision surgery. There are many reasons why a patient might need revision surgery. However, if you think you need revision surgery, it’s advised to consult a bariatric surgeon and see what they think should be done. Learn more about laparoscopic bariatric procedures in this article here! If you’re looking for weight loss surgery in Maryland, Maryland Bariatrics at Saint Agnes Medical Center can help. Procedures include sleeve gastrectomy, adjustable gastric band, duodenal switch, and Roux en Y in Maryland.

Does Insurance Cover Gastric Bypass Surgery?

Gastric bypass surgery, otherwise known as a roux-en-Y gastric bypass (RYGB), is the oldest bariatric procedure that is still performed by surgeons today. Its introduction was a breakthrough for treating obesity and thousands of Americans undergo the procedure every year. The one big barrier to gastric bypass surgery, even today, is the cost. The average cost of gastric bypass surgery is between $18,000 and $22,000, and most people are not going to be able to afford that. Therefore, it’ll be up to their insurance to determine whether or not they’re going to be able to afford the procedure. In this article, you will learn about whether or not your insurance covers gastric bypass.

Will Insurance Cover Gastric Bypass Surgery?

The answer is yes. The following bariatric procedures are covered under most insurance schemes: gastric bypass, gastric sleeve, and adjustable gastric band. Newer procedures or revision surgery might be a little bit more of a problem, though. To see what insurance covers gastric bypass, as well as their requirements for approval, check out this guide to Insurance Coverage for Bariatric Surgery. Does Medicaid cover gastric bypass surgery? The answer to that is that it depends. Medicaid’s coverage differs by state, and not all states will cover the same procedures. To see if your state’s Medicaid covers gastric bypass surgery, click here to go to the official government website for Medicaid and check your state’s coverage.

What Are The Requirements To Get Gastric Bypass Surgery Covered?

All insurance providers have different requirements for gastric bypass surgery. Not all providers will cover the same people, and depending on your qualifications, you may want to look at other options for paying for gastric bypass surgery. However, the requirements generally follow the same pattern. To qualify for gastric bypass surgery, you must:
  • Have a BMI over 40, OR
  • Have a BMI over 35 AND have one or more of the following obesity-related conditions: high blood pressure (hypertension), type 2 diabetes (T2DM), or sleep apnea;
  • Have a record of attempted weight loss with no lasting success
These requirements are there to make sure that bariatric surgery can be provided to those who need it most. Gastric bypass surgery is a big commitment and it’s expensive to provide. For this reason, only people who meet the qualifications are recommended for this surgery. If you’re looking for Roux en Y in Maryland, consider getting it done at Maryland Bariatrics at Saint Agnes Medical Center, one of the leading providers of weight loss surgery in Maryland.

FAQ: How Roux-en-Y Gastric Bypass Works

There are a few types of gastric bypass, including the mini gastric bypass and sleeve gastrectomy. However, the most popular choice is Roux-en-Y gastric bypass. So how does the Roux-en-Y gastric bypass work, and is this the right procedure for you?

How Roux-en-Y Gastric Bypass Works

The roux-en-Y gastric bypass is performed in two stages within a single procedure. Stage one is where a pouch is made in the stomach. Part of the stomach is stapled together so that the total volume that the stomach can hold is only about 8 fl oz. This is to restrict the amount of food that can be eaten at one time. Stage two is the bypass, where the stomach pouch is disconnected from the rest of the stomach and connected to a different part of the small intestine, or the jejunum. This procedure is laparoscopic for most patients, which means that tools are inserted in small incisions made in the body.

Risks of Roux-en-Y Gastric Bypass

Like any surgical procedure, there are risks of complications. Some risks associated with the surgery include: ● Infections: these are a risk for nearly any surgical procedure. However, the surgeons are prepared for this and this rarely results in anything serious like sepsis. ● Internal bleeding: This is usually rectified during the surgery itself and may increase the length of stay in the hospital. Rarer complications include: ● Blood clots, which could lead to pulmonary embolism. ● A staple line leak, which may require a revision surgery. In Summary ● Roux-en-Y gastric bypass is one of the most common forms of bariatric surgery. ● There are risks associated with the surgery that surgeons are prepared to deal with.

For more than 150 years, Ascension Saint Agnes Hospital has been dedicated to the art of healing by providing exceptional care to the greater Baltimore area. Built on a strong foundation of excellent medical care and compassion, Ascension Saint Agnes is committed to providing the best care for our patients for many years to come

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