Q: Which insurance providers partner with MSA, and of those, who approves weight loss surgery?
A: Click here for current lists.
Q: How long does the surgery last?
A: Each person’s case is different. But the operation usually lasts about two hours. After surgery, you will remain in the recovery room until your anesthesiologist clears you to be moved to your hospital room, usually about two to three hours after surgery.
Q: How long will I be in the hospital after surgery?
A: You will remain in the hospital until the surgeon has decided that you are stable enough to return home, usually one day. Adjustable gastric band patients may go home the same day.
Q: How much time will I need to take off from work?
A: The time that you take off from work depends on what type of work you do. After a laparoscopic approach most patients return to work in one or two weeks. You will have low energy for a while after surgery and may need to have some half days, or work every other day for your first week back. Your surgeon will give you clear instructions. Most jobs want you back in the workplace as soon as possible, even if you can’t perform ALL duties right away. Your safety and the safety of others are extremely important – low energy can be dangerous in some jobs.
Many patients are worried about getting hernias at incisions. That is almost never a problem from work or lifting. Hernias are more often the result of infection. You will not feel well if you do too much.
Q: Are all the operations done with a laparoscope?
A: Yes if your surgery is done laparoscopically. In this case, the surgeon makes several very small incisions. A tiny video camera is inserted through a small tube into the abdomen. The surgeon is able to see into the abdomen by watching the video from the camera on a nearby monitor. The surgeon watches the monitor and uses surgical instruments that have been inserted through other small incisions to perform the surgery. Dr. Mailapur is able to complete the operation using this technique in the vast majority of cases.
Q: Will the surgeon remove my gallbladder?
A: If you still have your gallbladder and it is causing you symptoms, the surgeon may request an ultrasound of your gallbladder to examine it better before your surgery, to determine whether removing it is necessary.
Q: Why does my hair fall out and how can I prevent that from happening?
A: Numerous metabolic changes occur after weight loss surgery. The number of calories your body is accustomed to consuming is drastically reduced. Hair loss is often minimal and the hair usually grows back. Consuming adequate amounts of protein and taking your multivitamins will reduce the amount of hair that may be lost.
Q: Is my surgeon in the operating room during the entire surgical procedure? Who else is in the room?
A: Your surgeon will be in the room and is the person in charge of all aspects of the operation. In most cases Dr. Mailapur will have another surgeon to assist him in performing the surgery, but he may be the only one. A resident and operating room nurses are often in the room to help with the surgery.
Q: Can the Roux-en-Y gastric bypass surgery be reversed?
A: The Roux-en-Y gastric bypass changes your gastrointestinal tract. Because nothing is removed during this bypass, it can be reversed. However, this operation should be viewed as a permanent change. If you are not ready for that type of commitment, bariatric surgery may not be the best option for you at this point.
Q: Will I ever be allowed to drink carbonated beverages?
A: It is not recommended to drink carbonated beverages after undergoing bariatric surgery.
Q: How much excess skin will I have?
A: There is no reliable way to predict the amount of excess skin you may have. Younger patients will have fewer problems with excess skin after weight loss but most patients will have excess skin that may require surgery for removal.
Q: Is there a good age at which to have this surgery?
A: Ages 15-65 are good years for weight loss surgery.
Q: How long after surgery will my energy level increase?
A: Your energy level may be low immediately following surgery. You will need about one to two weeks after laparoscopic surgery before going back to work.
Q: When can I start exercising after surgery?
A: Right away! You will take gentle, short walks even while you are in the hospital. The key is to start slow. Listen to your body and your surgeon. If you lift weights or do sports, stay “low impact” for the first month (avoid competition). Participate instead of competing at least for the first month. Build slowly over several weeks. If you swim, your wounds need to be healed over before you get back in the water.
Q: Can I have laparoscopic surgery if I have had other abdominal surgery procedures in the past, or have a hernia, or have a stoma?
A: The general answer to this is yes. Make sure to tell your surgeon and anesthesiologist about all prior operations, especially those on your abdomen and pelvis. Many of us forget childhood operations. It is best to avoid surprises!
Sometimes your surgeon may ask to see the operative report from complicated or unusual procedures, especially those on the esophagus, stomach, or bowels.
Q: Does Type 2 diabetes make surgery riskier?
A: It can. Be sure to follow any instructions from your surgeon about managing your diabetes around the time of surgery. Almost everyone with Type 2 Diabetes sees big improvement or even complete remission after surgery. Some studies have even reported improvement of Type 1 Diabetes after bariatric procedures.
Can I have laparoscopic surgery if I have heart disease?
A: Yes, but you may need medical clearance from your cardiologist. Bariatric surgery leads to improvement in most problems related to heart disease including:
- High Blood Pressure
- Lipid problems
- Heart enlargement (dilated heart, or abnormal thickening)
- Vascular (artery and vein) and coronary (heart artery) disease
During the screening process, be sure to let your surgeon or nurse know about any heart conditions you have. Even those with atrial fibrillation, heart valve replacement, or previous stents or heart bypass surgery usually do very well. If you are on blood thinners of any type, expect special instructions just before and after surgery.
Q: When can I get pregnant after metabolic and bariatric surgery? Will the baby be healthy?
A: Most groups recommend waiting 12-18 months after surgery before getting pregnant.Most women are much more fertile after surgery, even with moderate pre-op weight loss. Birth control pills do NOT work as well in heavy patients. Birth control pills are not very reliable during the time your weight is changing. For this reason, having an IUD or using condoms and spermicide with ALL intercourse is needed. Menstrual periods can be very irregular, and you can get pregnant when you least expect it!
Many women who become pregnant after surgery are several years older than their friends were when having kids. Being older when pregnant does mean possible increased risks of certain problems. Down’s syndrome and spinal deformities are two examples. The good news is that, after surgery, there is much less risk of experiencing problems during pregnancy (gestational diabetes, eclampsia, macrosomia) and during childbirth. There are also fewer miscarriages and stillbirths than in heavy women who have not had surgery and weight loss.
Kids born after mom’s surgery are LESS at risk of being affected by obesity later, due to activation of certain genes during fetal growth (look up “epigenetics” – for more information). There is also less risk of needing a C section.
Q:Will I need plastic surgery? Does insurance pay for plastic surgery?
A: Most patients have some loose or sagging skin, but it is often more temporary than expected. You will have a lot of change between 6 and 18 months after surgery. Your individual appearance depends upon several things, including how much weight you lose, your age, your genetics and whether or not you exercise or smoke. Generally, loose skin is well-hidden by clothing. Many patients wear compression garments, which can be found online, to help with appearance.
Some patients will choose to have plastic surgery to remove excess skin. Most surgeons recommend waiting at least 18 months, but you can be evaluated before that. Plastic surgery for removal of excess abdominal and breast skin is often covered by insurance for reasons of moisture, hygiene and rash issues.
Arms and other areas may not be covered if they are considered “purely” cosmetic by your insurer. Some of these “less invasive” operations can be done in the clinic, however – so they can be much more affordable.
Q: Will I have to take vitamins and minerals after surgery? Will my insurance pay for these?
A: You will need to take a multivitamin for life. You may need higher doses of certain vitamins or minerals, especially Iron, Calcium, and Vitamin D. You will also need to have at least yearly lab checks. Insurance almost never pays for vitamin and mineral supplements but usually does pay for labs. You can pay for supplements out of a flex medical account.
Q: If my insurance company will not pay for the surgery, are payment plans available?
A: There are loan programs available to cover the cost of health expenses such as metabolic and bariatric surgery. Appeals to insurance companies or directly to your employer may reverse a denial of coverage. Metabolic and Bariatric surgery is a health expense that you can deduct from your income tax.
If you are not able to qualify for a loan, the Obesity Action Coalition (OAC) produces a helpful guide titled “Working with Your Insurance Provider – A Guide to Seeking Weight-loss Surgery.” This guide can help you work with your provider and advocate for your surgery to be covered. You can view the OAC guide on their website.
Q: If I am self-pay but I have health insurance, will my insurance company pay the cost of post-operative complications?
A: Complications are often reported under a separate medical billing code. The insurance company may not cover these costs. Appeal is often very helpful, and direct contact with your hospital can make a big difference for final costs. Many surgeons also offer a special insurance policy to cover unexpected additional costs.
Q: Will I have to diet or exercise after the procedure?
A: No and Yes.
Most people think of a “diet” as a plan that leaves you hungry. That is not the way people feel after surgery. Eventually, most patients get some form of appetite back 6-18 months after surgery. Your appetite is much weaker, and easier to satisfy than before.
This does not mean that you can eat whatever and whenever you want. Healthier food choices are important to best results, but most patients still enjoy tasty food, and even “treats.”
Most patients also think of exercise as something that must be intense and painful (like “boot camp”). Regular, modest activity is far more useful in the long term. Even elite athletes can’t stay at a “peak” every week of the year. Sometimes exercise is work, but if it becomes a punishing, never-ending battle, you will not keep going. Instead, work with your surgeon’s program to find a variety of activities that can work for you. There is no “one-size-fits-all” plan. Expect to learn and change as you go!
For many patients (and normal weight people, too) exercise is more important for regular stress control, and for appetite control, than simply burning off calories. As we age, inactivity can lead to being frail or fragile, which is quite dangerous to overall health. Healthy bones and avoiding muscle loss partly depends on doing weekly weight bearing (including walking) or muscle resistance (weights or similar) exercise.
Q: What if I am unable to walk?
A: Almost everyone is able to find some activity to “count” as moderate exercise, even those who are partially paralyzed, or who have arthritis or joint replacement or spine pain. Special therapists may be needed to help find what works for you.
Q: How do I get a letter of necessity?
A: Some insurance requires this type of letter from either your surgeon or primary care provider before final approval for surgery. Many will just accept your surgeon’s consultation summary note. It is best to ask your insurer directly. Most companies want information pertaining to current weight, height, body mass index, the medical problems related to obesity, your past diet attempt history and why the physician feels it is medically necessary for you to have bariatric surgery. Your bariatric surgeon will often have a sample letter of necessity for you to take to your primary care physician.
Q: Can I go off some of my medications after surgery?
A: As you lose weight, you may be able to reduce or eliminate the need for many of the medications you take for high blood pressure, heart disease, arthritis, cholesterol, and diabetes. If you have a gastric bypass, sleeve gastrectomy or a duodenal switch, you may even be able to reduce the dosage or discontinue the use of your diabetes medications soon after your procedure.