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Does California Medi Cal Cover Weight Loss Surgery

Body Mass Index As A Criterion For Candidacy For Obesity Surgery

What I had to do for Medi-cal to pay for my WLS

Surgery for severe obesity is usually considered an intervention of last resort with patients having attempted other forms of medical management but without achieving permanent weight loss . Surgery is indicated for persons with severe obesity or for persons with a BMI of 35 kg/m2 or more and serious co-morbidities such as diabetes, coronary heart disease, or obstructive sleep apnea. Ideally patients selected for surgery should have no major perioperative risk factors, a stable personality, no eating disorders, and have lost some weight prior to surgery. The patient’s ability to lose weight prior to surgery makes surgical intervention easier and also provides an indication of the likelihood of compliance with the severe dietary restriction imposed on patients following surgery.

Sleeve Gastrectomy With Single Anastomosis Duodeno

Zaveri et al noted that the increase in the prevalence of obesity and gastro-esophageal reflux disease has paralleled one another. Laparoscopic fundoplication is a minimally invasive form of anti-reflux surgery. The duodenal switch is a highly effective weight loss surgery with a proven record of long-term weight loss success. However, fundoplication alone does not give satisfactory results when used for GERD in morbidly obese patients. These researchers presented a novel approach combining stomach intestinal pylorus sparing surgery with LF for morbidly obese patients with GERD. The data from patients who underwent the SIPS procedure along with LF in past year was retrospectively analyzed. The variables collected were age, sex, height, weight, intra-operative and post-operative complications, length of stay, operative time, and estimated blood loss. All revisions were excluded. Descriptive statistics such as mean and standard deviation were used to analyze the data. The total sample size of the study was 5 patients, with a mean age of 59.6 ± 16.4 years, a mean weight of 292.1 ± 73.6 lbs., and a mean body mass index of 43.4 ± 6.3. Weight loss patterns were the same as those without LF. All 5 patients had resolution or improvement in their GERD symptoms within 6 months. The authors concluded that SIPS with LF provided substantial and sustained weight loss and GERD resolution. however, long-term follow-ups and further study on this novel surgical technique is recommended.

Mini Sleeve Gastrectomy By Natural Orifice Trans

Erridge and colleagues summarized the clinical applications of natural orifice transluminal endoscopic surgery in bariatric surgery. These investigators carried out a review of data, until December 2014 regarding techniques and outcomes of bariatric NOTES procedures. A total of 9 publications were included in the final analysis, with another 6 papers describing endolumenal procedures included for comparison. All NOTES studies adopted a hybrid procedure. Hybrid NOTES sleeve gastrectomy was described in 4 humans and 2 porcine studies. In humans, 6 subjects were converted to conventional laparoscopic methods, and 1 post-operative complication was reported. Mean excess weight loss was 46.6% . The authors concluded that transvaginal-assisted sleeve gastrectomy appeared feasible and safe when performed by appropriately trained professionals. However, they stated that improvements must be made to overcome current technical limitations.

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Important Points To Know

  • If you use tobacco, you must stop at least six weeks before surgery to decrease your risk of postoperative complications. We strongly recommend quitting permanently to help you meet your health goals.
  • Please notify us of any change in your insurance coverage, as it could impact your approval for surgery. We will request verification of coverage for bariatric surgery from your insurance company about six weeks before the surgery.

UCSF Health medical specialists have reviewed this information. It is for educational purposes only and is not intended to replace the advice of your doctor or other health care provider. We encourage you to discuss any questions or concerns you may have with your provider.

Weight Loss Surgery California

Testimonials &  Reviews

Severe obesity is among the most serious of health hazards it can often shorten an individuals lifespan by 20 years or more and can greatly reduce the overall quality of life in the meantime. Unfortunately, most patients find that severe obesity is especially difficult to overcome however, the good news is that weight loss surgery makes permanent and significant weight loss more achievable.

The reason for this is that, while a reduced calorie diet and exercise is the one and only way to achieve a healthy weight loss, most people have a very difficult time sticking to a low-calorie regimen over a lengthy period. Some may be able to lose their weight temporarily, but few are able to maintain it over the long-term. Bariatric procedures, however, reduce the appetite and often produce hormonal and metabolic impacts which dramatically improve the odds of a patients ongoing success in the battle against obesity. The California weight loss surgeries offered by Michael Feiz, M.D., F.AC.S. of Dr. Feiz & Associates can give severely obese patients the opportunity for a lifetime of improved health and happiness.

Health Benefits of Weight Loss Surgery

Even with a procedure, weight loss always requires some effort. However, the health benefits are enormous. They include:

Types of Weight Loss Surgery

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Laparoscopic Adjustable Silicone Gastric Banding

Recent advances in laparoscopy have renewed the interest in gastric banding techniques for the control of severe obesity. Laparoscopic adjustable silicone gastric banding has become an attractive method because it is minimally invasive and allows modulation of weight loss. Available brands of LASGB include the Lap-Band System and the Realize Adjustable Gastric Band . The claimed advantage of LASGB is the adjustability of the band, which can be inflated or deflated percutaneously according to weight loss without altering the anatomy of the stomach. This method entails encircling the upper part of the stomach using bands made of synthetic materials, creating a small upper pouch that empties into the lower stomach through a narrow, non-stretchable stoma. The reduced capacity of the pouch and the restriction caused by the band diminish caloric intake, depending on important technical details, thus producing weight loss comparable to vertical gastroplasties, without the possibility of staple-line disruption and lesser incidence of infectious complications. However, distension of the pouch, slippage of the band and entrapment of the foreign material by the stomach have been described and are worrisome.

Does Medi Cal Cover Weight Loss Surgery For Gastric Bypass

According to the most recent data, 42.4% of Americans are considered obese. Despite the lower frequency in California, the Centers for Disease Control and Prevention estimate that 30.3% of the states population is obese . In this case, its not just about how you look. Diabetes, high blood pressure, heart disease, and a slew of musculoskeletal issues are all linked to obesity.

Such people have a diminished standard of living. Improved surgical procedures, on the other hand, offer some reason for optimism in the fight against obesity. Gastric bypass surgery is one such approach to consider. However, its a costly endeavor that typically yields positive results Gastric bypass surgery is more costly than other Medi-Cal-covered weight-loss options. As a result, insurance is a need for many people. Bariatric surgery cover by most insurance carriers, including Medi-Cal.

Medi-Cal is a federal Medicaid program manage by the state of California that provides low-income families and individuals with a wide range of health care services. The agency will pay for Medicaid-covered services, but only if there is a valid reason for doing so. An inquisitive patient must first get a referral to a Medi-Cal affiliated bariatric surgeon from their primary care physician. Patients who meet these requirements will receive a letter from their surgeon advising Medi-Cal that surgery absolutely require for their survival and well-being.

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Medicare Covers Bariatric Surgery Such As Gastric Bypass

Medicare covers a few different types of bariatric surgeries, each of which are designed to help patients lose weight. Covered procedures include gastric bypass, lap band, duodenal switch and sleeve gastrectomy.

The amount that Medicare pays for bariatric surgery depends on whether the procedure is performed as an inpatient or outpatient. Depending on where the surgery takes place, it may be covered by Medicare Part A or Part B. Medicare Advantage plans will provide at least the same coverage as they would be covered by Part A and Part B.

Medicare Part A pays for inpatient hospital costs, including your hospital stay costs such as your room and your food. Medicare Part B covers outpatient care, such as visits to your primary care doctor or an outpatient surgery center.

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Sclerotherapy For Dilated Gastrojejunostomy

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The textbook Townsend: Sabiston Textbook of Surgery states that, in regard to investigational bariatric procedures, âendoscopic incisionless surgery has focused on patients after Roux-en-Y gastric bypass who have inadequate weight loss or significant weight regain and who have a dilated gastrojejunostomy. It is thought that these patients lose restriction because of the dilated gastrojejunostomy and thus overeat. Surgeons have tried endoscopic injection of sclerosing agents to create scar and a smaller anastomosis, with variable effects.â

In a 2007 article, Spaulding, Osler and Patlak studied endoscopic sclerotherapy with sodium morrhuate of a dilated gastrojejunostomy in 147 gastric bypass patients. In a retrospective review, 32 patients were identified for whom > or =12 months of postprocedure data were available. Their weight trends before and after treatment were assessed by paired t test. A total of 32 patients who were gaining weight after gastric bypass underwent sclerotherapy of their dilated gastrojejunostomy. The timing of treatment ranged from 10 to 140 months after Roux-en-Y gastric bypass. Before sclerotherapy, patients were gaining weight at a rate of .36 kg/mo. After treatment, they were losing weight at a rate of .39 kg/mo. After treatment, 56.3% of patients began to lose weight, 34.4% had their weight stabilize, and 9.4% continued to gain weight.

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Requirement That Obesity Be Persistent

Obesity surgery is not indicated for persons with transient increases in weight . Guidelines of the American Association of Clinical Endocrinologists and the American College of Endocrinology and guidelines on obesity surgery from the Massachusetts Department of Health and Human Services state that surgery candidates should be severely obese for a period of time.

Best Tweets Of All Time About Does California Medi

One of the largest companies in the world and the leader in the healthcare industry, Cal Medica has over 200 locations in California and has been named to the Fortune 500 list of companies for five consecutive years. As a result, medical doctors and hospitals trust Cal Medicas medical expertise and services.

Cal Medica offers a wide range of programs from medical detox to weight loss surgery. The company started in 1961 as the California Medica Corporation, and after that, they became Cal Medica Corporation. They are known to offer weight loss surgery through California hospitals, as well as from private medical clinics. They only work with local hospitals, but they do provide some of their services through their website, so check it out.

Cal Medica can also work with individuals to do weight loss surgery, and they can also provide medical detox. They charge anywhere from $1,000 to $2,000 for weight loss surgery. Weight loss surgery is a popular option for men and women. Weight loss surgery usually involves cutting out excess weight, reducing the size of the stomach, removing some or all of the stomach contents, and then changing the shape.

I guess the medical detox isnt really a good option if you have a history of substance abuse, but its the only option for a lot of people. Medical detoxes are really only available in the U.S.

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Requirement For Psychological Evaluation

Candidates for obesity surgery who have a history of severe psychiatric disturbance or who are currently under the care of a psychologist/psychiatrist or who are on psychotropic medications should undergo a comprehensive evaluation by a licensed psychologist or psychiatrist to assess the patients suitability for surgery, the absence of significant psychopathology that can limit an individuals understanding of the procedure or ability to comply with life-long follow-up .

Your Partners In Weight

Our Surgical Weight Loss Center is a comprehensive program designed to provide our patients with support throughout their journey.

  • Personalized navigators guide each patient through the process, review eligibility, and assist with insurance requirements.
  • New Patient Class provides an overview of the surgical weight-loss journey.
  • Psychological assessment ensures patients are mentally prepared and equipped for this life change.
  • Weekly support groups are available before and after surgery.
  • Nutritional education and support for optimal health benefits.
  • A nurse navigator assists and answers questions throughout hospitalization and after surgery.

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What Are The Types Of Weight

Depending on whether your weight-loss surgery is to make your stomach smaller or to change the path of your intestine, your doctor will perform one of these procedures:

Adjustable gastric banding.

The doctor wraps a band around the upper part of the stomach to make the stomach smaller.

Gastric sleeve.

The doctor removes more than half of your stomach, leaving a thin vertical sleeve, or tube.

Gastric bypass.

The doctor uses a small part of your stomach to create a smaller stomach. This is connected to the middle part of the small intestine. Food skips the rest of the stomach and part of the small intestine. This surgery is called a Roux-en-Y gastric bypass.

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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.

United Healthcares Criteria For Weight Loss Surgery Coverage

California Rehabilitation Institute

United Healthcare is a large insurance company that provides health care services to people across the United States. They have recently changed their criteria for weight loss surgery coverage.

The new criteria are as follows:

1) Patients must have a BMI of 40 or above

2) The patient must be under 18 years old

3) Patients must have a BMI of 35 or below and be at least five years post-surgery. This is because most patients who undergo weight loss surgery do not achieve their desired weight in time and will not qualify for the surgery.

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How Do I Get Approved For Weight Loss Surgery

Getting approval for weight loss surgery can be a very lengthy process, but it doesnt have to be as painful as you think. In order to get approval for weight loss surgery, you should visit your primary care physician as well as a nutritionist to establish a healthy weight loss plan. From there, you should research your surgeon thoroughly, as he or she will play a huge role in the long-term success of your weight loss plan..

Contact Us To Learn More About Medicare And Weight Loss Surgery

Struggling with your weight can be frustrating and is often a lifelong struggle. Weight loss surgery can help some people radically change their eating habits so that they can finally lose the weight thats threatening their health.

If you have questions about how Medicare covers weight loss surgery, or youre interested in comparing Medicare plans to get the best coverage for your needs, were here to help. Contact us today for more information!

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