Weight Loss (Bariatric) Surgery

Weight loss surgery is the beginning of a lifelong commitment to health. Dedication to proper diet, exercise and mental health are crucial for obtaining the best results. Bariatric surgery is a tool that improves your ability to lose weight while following the diet and exercise program 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 with extensive experience
• Nutrition counseling to discuss the dietary changes necessary for bariatric surgery
• Exercise consultation about appropriate levels of exercise and intensity
• 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. Our team wants to you to be fully aware of the commitments both before and after surgery. During your initial consultation, the surgery team will help you understand the weight loss surgery program at UnityPoint Health and determine if you’re an appropriate candidate. Depending on your location, the process may look something like this:

1. Meet the qualifications for surgery by the time you have the procedure
2. Take an in-person seminar to prepare and educate yourself
3. Schedule an appointment with your weight loss provider
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 for surgery
7. Take the required medical evaluations
8. Wait for your team's medical approval
9. Insurance approves surgery
10. Weight loss team will educate you on pre-surgical information
11. Undergo surgery
12. Maintain your follow-up care

Bariatric Surgery Requirements and Qualifications

To be considered as a candidate for surgery, most insurance providers require certain criteria are met.

• 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 believe the care you need after bariatric surgery is most successful with a comprehensive team approach. This means you’ll have a follow-up care schedule over the course of several weeks to months after your procedure, which could include:

• Dietary and mental health counseling
• Exercise consultation
• Reconstructive surgery

Bariatric Surgery Insurance Coverage

Pre-Insurance Approval

Many insurance plans cover weight loss surgery if you meet the National Institute of Health guidelines. It’s your responsibility to contact your insurance company to be sure they’ll pay for the surgery. Here are some questions to ask:

• 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, call the customer service number on your insurance card to make sure your plan covers weight loss surgery. Tell the customer service representative you’re interested in bariatric surgery and ask if the service is covered by your plan. You may have to use phrases like, “morbid obesity surgery,” “weight loss surgery” or "bariatric surgery." If the service isn’t covered or is excluded, this means your employer, or whoever you get your insurance through, didn’t pay for this benefit. You may contact our office regarding cash payment options. Ask questions, including:

• What’s my co-insurance and deductible for bariatric surgery?
• Is there an out-of-pocket maximum for this procedure? Is there a lifetime maximum for weight loss surgery?
• If they say yes, or tell you it must be deemed "medically necessary,” ask the following questions:
  • What are your BMI requirements?
  • Do I need certain co-morbid conditions (medical conditions related to your weight)? If so, what are they?
  • 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 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's 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 to discuss their weight loss goals, an exercise plan, nutritional changes and have their current weight and height documented. It’s important your physician thoroughly documents everything discussed at these visits in your chart. Some insurance companies require patients to be on these diets for a period before surgery; others require patients to meet with a dietitian or nutritionist, too. If this is a requirement of your insurance plan, we can’t submit your pre-approval until this diet is completed. 
• I think I 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 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 already completed.
• Is a letter from my physician good enough?  It depends. Check with your insurance company to see what they require for insurance approval. Most insurance companies require more than just a letter. Insurance companies want to see that the patient and doctor met routinely in the office. Most also want to track fluctuations in weight from each visit. It’s 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 are available, such as bariatric support groups, even for those who didn’t have bariatric surgery at UnityPoint Health. We strongly recommend this support group to all patients as a great deal of information is exchanged by interacting with the other patients in the support group. Morbid obesity impacts many people, and you’ll find it easier to go through this life-changing surgery after talking with others who’ve experienced it.

Pre-Surgical Visit: After receiving approval from your insurance company, you’ll meet with our team for a final pre-surgery visit, where you can expect the following:

• Schedule your bariatric surgery, and ask the surgeon questions.
• 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 stomach ulcer-causing bacteria. You’ll be treated with antibiotics prior to surgery if you have it.

Bariatric Surgery: The procedure takes 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 specialists:

• Surgeon: Weight loss surgeons have extensive experience with critical care patients and provide comprehensive and complete care for any medical and surgical needs.
• Physician's assistant: Our physician's assistant helps with all surgical cases and your care while you’re 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’ll have scheduled visits with the surgeon and other members of the weight loss surgery team. During these visits, weight loss, diet and physical activity are reviewed. Examinations and tests are 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 are provided, learning to use these tools properly takes time. Patients must make attitude and habit changes related to eating, coping with stress and pleasure-seeking to ensure hunger is controlled and overeating or frequent snacking doesn’t occur.