Gastric band surgery is a type of bariatric, or weight loss, surgery that reduces the capacity of the stomach without permanently changing the digestive system. The surgeon divides the stomach into two smaller pouches with an adjustable silicone band filled with saline--salt water--that can be tightened or loosened by injecting or withdrawing the saline, according to the National Institutes of Health. If you are interested in gastric band surgery, your insurance carrier may require a referral or letter of medical necessity from your primary care provider. Your PCP can help you decide if the procedure is right for you.
Step 1
Gather information about the surgical procedure from magazines, books, websites and former patients. Consider possible side effects, the expected rate of weight loss, diet and activity recommendations and long-term success rates to determine if the procedure may be right for you.
Step 2
Calculate your body mass index using a BMI calculator to determine if you meet the minimum weight qualification for gastric band surgery. The BMI is calculated by dividing the patient's weight in kilograms by the square of his height in meters. Bariatric surgeons and insurance carriers require a BMI of 40 or higher for a patient to be considered for weight-loss surgery. Patients with a BMI between 35 and 39.9 may also be qualified if they have serious obesity-related conditions such as diabetes or sleep apnea, according to NIH.
Step 3
Contact your health insurance carrier to determine if the procedure is covered and, if so, how much you are expected to pay out-of-pocket. If your carrier covers part or all of the cost of the procedure, ask what patients are expected to do to qualify. Carriers vary widely in their expectations: some require only a referral from the PCP and documentation of morbid obesity, while others ask for evidence of past weight loss attempts, according to LapBandSolutions.
Step 4
Make a list of your past attempts at weight loss and the results or draw a graph of your history of weight gains and losses. If you have medical records that show these changes, request copies from the health care providers.
Step 5
Locate a bariatric surgery weight loss center near you. Register for a no-cost seminar or speak to the coordinator about your situation to determine if you qualify for gastric band surgery.
Step 6
Write down your reasons for wanting gastric band surgery, including the effects of excess weight on your health and lifestyle. If you are under treatment for diabetes, sleep apnea or other obesity-related conditions, request copies of those records.
Step 7
Make an appointment with your primary care provider. If you are concerned about not having enough time to discuss weight loss surgery, ask for an early morning appointment when your PCP may be less rushed.
Step 8
Bring your lists, printed information and medical records with you to the doctor's office. If he agrees that you are a candidate for gastric band surgery and is willing to submit a letter or referral, it will be helpful to have all of the information with you that he will need.
Step 9
Tell the office staff when you check in that you want to discuss weight loss surgery. Even if there are other matters to discuss during the appointment, such as laboratory test results or medications for other conditions, your PCP will know to leave enough time to discuss surgical options.
Step 10
Discuss your concerns about your weight candidly and without embarrassment. Obesity is a medical problem that impacts on the quality of your life. Be proud that you have made the decision to do something about it and ask for your doctor's support.
Step 11
Demonstrate that you have done the research and meet your insurance carrier's qualifications. Provide your PCP with your lists and printed information and ask for her opinion.
Step 12
Listen to your PCP's opinion and concerns. If he believes that your medical history makes you a poor candidate for surgery, ask what you can do to improve your health. If he is concerned about your smoking or alcohol consumption, ask about ways to help you quit.
Step 13
Ask for a referral or letter of medical necessity if your PCP considers you to be a good candidate for the surgery. Describe your insurance carrier's requirements and offer to obtain any additional information that she may need. A well-documented request is more likely to be approved by the carrier.
Step 14
Speak up politely if your PCP's response is negative. Some physicians believe that weight loss surgery is the easy way out and refuse to recommend it to anyone. If you meet your insurance carrier's criteria for the surgery, ask your PCP to reconsider or at least speak to a bariatric surgeon about your case. If she refuses, consider asking for a change in primary care provider.
Tips and Warnings
- Gastric band surgery is also called lap band surgery or adjustable gastric banding.
- Gastric band surgery is less invasive than other weight loss procedures, but the rate of weight loss is slower and usually amounts to only one-third to one-half of the patient's excess body weight, according to the National Institutes of Health.
Member Comments