Programs such as ‘Medicaid’ and ‘CHIP’ in your state can cover the medical costs for a wide range of services to prevent and treat obesity.
Screening of Body Mass Index (BMI), education, and counseling on nutrition and physical activity, prescription drugs that promote weight loss, and even some major weight loss or bariatric surgeries, can all be covered and paid for under this program.
For bariatric surgeries, however, you need to meet the following criteria to qualify for the coverage:
- The patient should be at least 18 years of age.
- The patient should be diagnosed with obesity with a Body Mass Index (BMI) over 40 or;a BMI over 35 with diabetes or at least two other serious obesity-related comorbidities such as hypertension, coronary heart disease, mechanical arthropathy in major weight-bearing joints, or sleep apnea.
- The patient should have undergone the following four evaluations and qualify the conditions: –
- Psychosocial evaluation should be conducted by a licensed mental health professional to assess the patient’s mental capacity to undergo the surgery. This is to ensure the patient is free from any mental or behavioral disorder that may interfere with postoperative outcomes, a 6-month abstinence period from drug abuse such as alcohol or marijuana should be certified for the surgery. Frequent tests for the same will be conducted as part of this evaluation process. Patients with a previous psychiatric illness must be stable for at least six months from the operation.
- Medical evaluation should be conducted by the patient’s primary care provider to assess his physical condition for the operation and mortality risk associated with it. This evaluation should also ensure the medical control of related comorbid conditions, if any, such as diabetes or hypertension that could introduce complications to the surgery. Female patients should not be currently pregnant and have plans for the same for at least 2 years post-surgery.
- Surgical evaluation should be conducted by a licensed bariatric surgeon associated with the program that ensures that the patient is an appropriate candidate for the surgery. This procedure would also ensure that the patient is made aware of the many potential complications of the surgery (including death) and the realistic expectations of post-surgical outcomes.
- Dietician evaluation should be conducted by a licensed dietician that certifies that the patient has undergone efforts to lose weight before the surgery. If no such dietary effort is found to have taken place, the patient must undergo a 6-month clinically supervised weight reduction program that includes intensive nutrition and physical activity counseling.
So exactly how long does it take Medicaid to approve weight loss surgery?
Well, it depends on how seriously you require surgery and how strong and compelling the results of your evaluations turn out to be. 6 months of intensive counseling might be mandatory for every potential candidate.
And during this time if it is found that there are considerable weight loss and improvement in your cardiovascular risk factors, then such a counseling period may be extended for another 6 months (up to a year in total).
So, you can expect anywhere from 6 months to a year for getting approval and undergoing the surgery.
What are the different kinds of weight loss surgeries covered by Medicaid?
Gastric bypass surgery:
It is one of the most common types of weight-loss surgeries in which the surgeon divides a patient’s stomach into 2 sections and rearranges his small intestine to connect to both.
This procedure alters the way his body handles the food he eats. After the surgery, his stomach would be smaller so he will feel full with less food. His body will not get all of the calories from the food he eats because of this rearrangement.
Laparoscopic adjustable gastric banding:
a.k.a Lap band surgery, is a surgical procedure where an adjustable belt is placed around the upper portion of the stomach us a laparoscope, which is a small camera inserted into your belly.
This band is connected to a port that is placed under the skin of the abdomen and is used to introduce or remove saline in the band. Since the band is made from silicone, adding saline will tighten the band.
This tightening will restrict the size of the stomach, the amount of food it can hold, and also slow the passage of food into the intestine. This signals to the brain a sensation of fullness even by eating less food.
Gastric sleeve surgery:
a.k.a Vertical sleeve gastrectomy, is a surgical procedure where the surgeon removes 75-80% of a patient’s stomach. The edges of the remaining 20% of his stomach are stapled or sutured together.
Again, this procedure curbs the amount of food you eat every time so this decreases the total calories your body absorbs.
Also, this operation removes the part of your stomach that produces ‘ghrelin’ which is the hormone associated with hunger so your body won’t feel as hungry as they used to.
According to the American Society of Metabolic and Bariatric Surgery, you can expect to lose at least 50% of your excess weight within the next 18-24 months following this surgery.
While weight-loss surgeries should only be considered as the last resort after trying out all the rigorous weight loss methods, diets, and other medications.
And although it is the only treatment type associated with large risks and complications compared to the others, it doesn’t mean that bariatric surgeries are extremely dangerous in practice, however.
The likelihood of any major complications from weight loss surgeries is only 4%, according to a 2013 study published in ‘The New England journal of medicine’.
If you are planning to proceed with your bariatric surgery under the Medicaid program, you have even fewer reasons to worry about the risks involved as this program itself mandates that “All surgical services must be provided by a program with current accreditation by the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program”.
This ensures you get the most advanced and professional medical treatment.
And also, the post-surgical attention you receive as part of this program that involves regular follow-up with professional nutritionists, psychologists, physical therapists, and various support group participation programs, will altogetherensure you enjoy the best treatment and recovery sessions available, with this Medicaid program.