Friday, June 14, 2024

Does Medicare Cover Gastric Bypass Revision

Don't Miss

Will Medicare Pay For Gastric Bypass Revision Surgery

Medicare Stomach Care | Will it Cover Your Bariatric Surgery?

I know that medicare will pay for gastric bypass but does it also cover the surgery to have it reversed.

Answer by Rubberchicken

Medicare will likely not pay for gastric bypass surgery unless a second opinion from a doctor shows that the surgery is needed for assistance in other concurrent health issues, such as diabetes. In the vast majority of obesity cases, Medicare will look for other obesity management alternatives.

Answer by Roland27

That is something that you’re going to need to call Medicare and talk to them about. It varies state by state what they cover so it’s always best to ask BEFORE you get the procedure done to avoid finding out later that for some reason you won’t be covered and you have to pay the bill yourself.

The Overstitch Suturing Device

Bolton et al stated that weight regain secondary to VBG pouch dilation is a typical referral for bariatric surgeons. In this study these investigators compared an endoluminal pouch reduction to RYGB for revision. A retrospective review was completed for patients with a previous VBG presenting with weight regain between 2003 to 2010. A total of 30 patients were identified . Significant post procedure BMI loss was seen in each cohort to 35 ± 7 kg/m StomaphyX 43 ± 10 kg/m to 40 ± 9 kg/m, p = 0.0007). Whereas nausea and headache were the only complications observed in StomaphyX patients, the RYGB group had a 43.5 % complication rate and 1 mortality. Complications following RYGB include: incisional hernia , anastomotic leak , respiratory failure , fistula , and perforation . The median length of stay following RYGB was 6 days compared to 1.5 ± 0.5 days following StomaphyX. The authors concluded that the findings of this study suggested that while RYGB revision may achieve greater weight loss, the complication rates and severity is discouraging. StomaphyX may be a safe alternative. Moreover, they stated that further technical modifications of the device and longer follow-up may clarify the role of this approach.

When To Revise A Weight Loss Surgery

A small number of patients who have weight loss surgery relapse years later. How much depends on the procedure they originally had to address their obesity. These individuals may benefit from an additional procedure, called revision surgery, to help them lose again and treat specific symptoms.

There are many different factors that might contribute to weight regain. Revision surgery may be done because the patient’s anatomy has changed over time and needs repair. “Patients also come to us for help because they’ve gained weight related to behavioral changes or some new stress in their lives,” says Dr. Abraham Krikhely, of the Columbia Center for Metabolic and Weight Loss. “Others have had gastric band procedures and now see their friends or family members getting better results after the sleeve gastrectomy or the gastric bypass. Now they want these benefits.”

In this interview, Dr. Krikhely describes when and how revision surgery can help.

Why do some individuals end up putting the pounds back onregaining enough weight to consider another operation?

Obesity is a chronic disease, and while weight loss surgery can be life-saving, it is not a cure. Its success also depends upon one’s ability to stick to certain lifestyle and nutrition guidelines.

We also learn from our experience as surgeons. Today we can do things that were not available ten years ago. And so, some patients come to us asking for a new procedure that will make it easier for them to lose weight faster.

Recommended Reading: How To Get Motorized Wheelchair Through Medicare

Before You Get Weight Loss Surgery It Is Always Best To:

  • Talk to your doctor about all of your options
  • Clarify with the hospital or facility conducting your procedure how much you might pay for the surgery and aftercare
  • Be aware of how much you may owe on your deductible, as this amount needs to be satisfied before Medicare can start to pay
  • Know that copayments may still apply for the care you receive

Note: This material is provided for informational use only and should not be construed as medical advice or in place of consulting a licensed medical professional. You should consult your doctor to determine what is best for you.

  • National Coverage Determination for Bariatric Surgery for Treatment of Co-Morbid Conditions Related to Morbid Obesity , Centers for Medicare & Medicaid Services, last accessed August 25, 2020,.
  • Explore Medicare

    Gastrointestinal Liners For The Treatment Of Obesity

    Does Medicare Cover Weight Loss Surgery?

    Endoscopic duodenal-jejunal bypass is the endoscopic placement of a duodenal-jejunal bypass sleeve which lines the first section of the small intestine causing food to be absorbed further along the intestine. Once implanted, the device is purported to influence gastrointestinal hormones and satiety. It is suggested to promote weight loss in individuals who are potential candidates for bariatric surgery, but are too heavy to safely undergo the procedure.

    An UpToDate review on “Bariatric surgical operations for the management of severe obesity: Descriptions” lists “Endoscopic gastrointestinal bypass devices” as investigational. It states that “Endoscopic gastrointestinal bypass devices A barrier device is deployed to prevent luminal contents from being absorbed in the proximal small intestine. The EndoBarrier is 60-cm long and it extends from the proximal duodenum to the mid-jejunum and thus mimics a duodenojejunal bypass. It is a safe procedure but is hallmarked by an up to 20 % rate of early removal due to patient intolerance. The ValenTx is a 120-cm barrier device that extends from the gastroesophageal junction to the jejunum. This too has a high rate of early removal, but excess weight loss at 3 months was reported to be 40 %, and significant improvement was seen in 7 out of 7 diabetic patients within those 3 months. Data are still lacking about the longevity of these endobarriers and their outcomes once the barrier is removed”.

  • study personnel were not blinded, and
  • Don’t Miss: Does Medicare Medicaid Cover Dentures

    How Much Is Covered

    The extent of the Medicare coverage varies depending on the plan that you are involved in. This said, most Medicare base plans cover 80 percent of the amount of the surgery that is considered to be approved by Medicare. The rest may be covered by the MediGap supplement plan and could leave you with no expenses left to pay.

    Silastic Ring Vertical Gastric Bypass

    The Fobi pouch, developed by California surgeon Mathias A.L. Fobi, is a modification of gastric bypass surgery. The modifications to gastric bypass surgery are designed to prevent post-surgical enlargement of the gastric pouch and stoma.

    In a traditional gastric bypass procedure, surgeons create a smaller stomach by stapling off a large section. A problem with the traditional procedure is that the staples can break down, causing the stomach to regain its original shape and patients to start gaining weight again. Also, the stomach opening that leads into the intestines, which in surgery is made smaller to allow less food to pass through, often stretches as the years go by. With the Fobi pouch, there is no use of staples rather, the stomach is bisected and hand-sewn them to maintain the separation. A synthetic band is placed around the stomach opening to keep it from stretching.

    However, there is a paucity of direct comparative studies of the Fobi pouch to traditional gastric bypass surgery, causing colleagues to “question whether his technique is really an improvement on the traditional procedure” . All of the published literature has been limited to descriptive articles, case series, and a prospective non-randomized controlled study. These studies were from a single group of investigators, raising questions about the generalization of the findings.

    You May Like: What Is The Difference Between Medicare

    Do I Need Revisional Weight Loss Surgery

    A growing number of weight loss surgery patients are considering revisions due to relapse years after. The primary reason is due to inadequate weight loss, and even weight regain. Numerous factors can impact the patients weight progress. Firstly, many patients will realize they may not have chosen the most efficient option to address their obesity. For instance, those who opted to get a gastric band now understand this choice did not provide maximum weight loss potential. Some will admit to unhealthy behavioral habits due to unforeseen situations that led to this outcome. Even more, the bodys anatomy changes over time, which can cause chronic discomfort and interrupt how your food intake and energy are processed.

    Regardless of the circumstances, it is essential to recognize the problem and get back on track. For some, getting extra help from a support group or a professional is enough, while others may benefit from bariatric revision weight loss surgery to help with restarting the weight loss process and treating any complications from the initial procedure.

    *** Thanksgiving Recipes ***

    Gastric Sleeve Revision Surgery Approved

    These roasted brussels sprouts get a fair amount of spice from the crushed red pepper flakes, which cuts…

    After trying every turkey-roasting method under the sun, I’ve finally settled on this as absolutely the…

    We love how the cinnamon-scented streusel topping lets the juicy berries peek through.

    Italian sausage and a heap of Parmesan cheese lend signature flair to the easy Thanksgiving dressing…

    It’s all about the layers and ruffles in this dramatic seasonal pie.

    Poach quince in rosé with a dash of cocktail bitters and a few warm spices, then assemble into a tart…

    Leave the sausage, nuts, dried fruit behind in favor of this easy, vegetarian-friendly stuffing recipe…

    Alton Brown’s turkey brine recipe from Good Eats will give you a flavorful Thanksgiving turkey with juicy…

    Bone-in turkey breasts are easy to find, and as impressive as a whole bird when you roast them in butter…

    This recipe was handed down by my great-grandmother. It is a family favorite that we make every Thanksgiving….

    Cutting leeks into large pieces gives them a presence equal…

    This crunchy crumble is the perfect topping for an ice cream sundae, easy apple crumble, or our Build-Your-Own…

    Also Check: Are Hearing Aids Covered By Medicare Part B

    How Can I Get A Free Gastric Sleeve

    Free Weight Loss Surgery Grant

  • You must be approved for weight loss surgery.
  • You must be without insurance or have been denied either full or partial coverage for obesity surgery.
  • You must be willing to raise 10% of the funds you request for bariatric surgery by donating time and resources to the WLFSA.
  • 13.06.2020

    Medicare Options & How To Apply


    • Medicare Part A, B, C, & D Explained

    Applying for coverage for a Medicare plan depends on your goals and situation. As long as you meet the eligibility criteria described above, following are your options:

    Part A

    As explained above, qualifying individuals are usually automatically enrolled in part A unless explicitly choosing to enroll in a Medicare Advantage plan . As long as you or your spouse paid Medicare taxes during your workinglife, Part A will usually be offered at no charge.

    You also have the choice to pay for Part A as a part of a Medicare Advantage plan.

    Part B

    If you receive Social Security, you will be automatically enrolled in Part B.

    If you do not, you can apply for both Social Security and Medicare at the same time three months before the month you turn 65. See formore information.

    You can also enroll in Part B via a Medicare Advantage program

    Part C

    If you want more robust benefits than Parts A and B offer including prescription drugs, dental, vision or hearing and the option for lower out-of-pocket costs for doctor and hospital visits, Medicare Advantage is the way to go.

    Part D

    To obtain Medicare Prescription Drug coverage, you are required to have Medicare Part A and/or Part B. To get prescription drug coverage through a Medicare Advantage Plan, enrollment in Part A and Part B is mandatory.


    Also Check: Is Entyvio Covered By Medicare Part B

    Potential Causes Of Post

    • 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 isnt 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.

    What Is A Gastric Sleeve Revision

    How to Pay for Bariatric Surgery Without Insurance

    Gastric sleeve revision is a type of bariatric surgery. It is often considered an option whenever the primary gastric sleeve did not satisfy the patient.

    In a gastric sleeve revision, the surgeon removes a portion of the patients stomach and joins what remains of it, forming a sleeve-like shape. After the operation, the patients stomach will be easier to get filled, meaning he/she will not be able to eat as much as he/she did before.

    This should result in weight loss. To add to that, the surgery will remove the portion of the patients stomach that produces a hormone that boosts his/her appetite.

    This surgery is recommended for people who have a BMI of at least 40 and have tried diet and exercise but did not have any effects.

    The surgery will start with the surgeon making a few incisions in your belly. The surgeon will then insert a tiny camera called a laparoscope and will take pictures and send them to the computer.

    Then the surgeon will insert other medical instruments to remove approximately ¾ of your stomach. After that, the rest of your stomach will be reattached. After the surgery, you will have to stay in a hospital for 2-3 days.

    Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.

    Recommended Reading: How To Qualify For Medicare Disability

    Private Health Coverage For Weight Loss Surgery

    Furthermore, Private Health Funds will cover the hospital fees associated with any procedure that has an Item Number, including weight loss surgery.

    Private Health Funds usually offer different levels of cover depending on your monthly premium or plan.

    As is common with most procedures, there is usually an out-of-pocket gap that the patient must pay as the rebates from Medicare and Private Health Funds are not sufficient to cover all the associated costs with our complete

    Experimental And Investigational Bariatric Surgical Procedures

    Aetna considers each of the following procedures experimental and investigational because the peer-reviewed medical literature shows them to be either unsafe or inadequately studied:

  • Adjunctive omentectomy to bariatric surgery
  • AspireAssist aspiration therapy
  • Band over bypass or LASGB revision of prior Roux-en-Y gastric bypass
  • “Band over sleeve” or LASGB revision of prior sleeve gastrectomy
  • Bariatric surgery as a treatment for idiopathic intracranial hypertension
  • Bariatric surgery as a treatment for infertility
  • Bariatric surgery as a treatment for type-2 diabetes in persons with a BMI less than 35
  • Conversion of a sleeve gastrectomy to a Roux-en-Y gastric bypass for the treatment of bile reflux
  • Conversion to sleeve gastrectomy for hypoglycemia post-RYGB
  • Gastric bypass as a treatment for gastroparesis
  • Gastroplasty, more commonly known as stomach stapling
  • Laparoscopic gastric diversion with gastro-jejunal reconstruction for the treatment of GERD with esophagitis
  • Laparoscopic gastric plication , with or without gastric banding
  • LASGB, RYGB, and BPD/DS procedures not meeting the medical necessity criteria above
  • Liposuction
  • Loop gastric bypass
  • Mini gastric bypass
  • Natural orifice transoral endoscopic surgery techniques for bariatric surgery including, but may not be limited to, the following:
  • Gastrointestinal liners or
  • Intragastric balloon or
  • Mini sleeve gastrectomy or
  • Transoral gastroplasty or
  • Use of any endoscopic closure device in conjunction with NOTES
  • You May Like: How To Pay For Medicare Without Social Security

    Estimating The Cost Of Getting Bariatric Surgery

    Its hard to know exactly how much your weight loss surgery may cost because its difficult to determine what services you may need during and after your procedure. If you are at an inpatient hospital, then Medicare Part A will help cover costs. If your weight loss surgery is performed at an outpatient center, then Medicare Part B will assist with these costs.

    Since Original Medicare doesnt cover the entire cost of the surgery, you can also consider buying a Medicare Supplement plan to help offset any out-of-pocket expenses you may incur, such as some of the deductibles, copayments or coinsurance.

    Medicare Advantage plans must cover the same benefits as Original Medicare, but many offer additional benefits such as prescription drug coverage and an annual out-of-pocket maximum.

    Bariatric Surgery For The Treatment Of Idiopathic Intracranial Hypertension

    Sclerotherapy For Gastric Bypass Revision

    Levin and colleagues stated that IIH occurs most frequently in young, obese women. Gastric bypass surgery has been used to treat morbid obesity and its co-morbidities, and IIH has recently been considered among these indications. These investigators presented a case report of a 29-year old female with a maximum BMI of 50.3 and a 5-year history of severe headaches and moderate papilledema due to IIH. She also developed migraine headaches. After a waxing and waning course and various medical treatments, the patient underwent laparoscopic Roux-en-Y gastric bypass surgery with anterior repair of hiatal hernia. Dramatic improvement in IIH headaches occurred by 4 months post-procedure and was maintained at 1 year, when she reached her weight plateau with a BMI of 35. Pre-surgery migraines persisted. This added to the small number of case reports and retrospective analyses of the successful treatment of IIH with gastric bypass surgery, and brought this data from the surgical literature into the neurological domain. It offered insight into an early time course for symptom resolution, and explored the impact of weight-loss surgery on migraine headaches. The authors concluded that this treatment modality should be further investigated prospectively to analyze the rate of headache improvement with weight loss, the amount of weight loss needed for clinical improvement, and the possible correlation with improvement in papilledema.

    Recommended Reading: How Long Does It Take For Medicare To Become Effective

    More articles

    Popular Articles