Bariatric Surgery FAQs
What if insurance does not cover my surgery?
There are a number of financing programs that may be able to help cover the cost of metabolic and bariatric surgery. In some cases, appealing your insurance company or going directly to your employer can reverse a previous denial of coverage. If you do not qualify for a loan, this helpful resource from the Obesity Action Coalition (OAC) can be used to guide you through advocating for coverage from your insurance company. Please note that metabolic and bariatric surgery is considered a health expense that can be deducted from your income taxes.
If I have health insurance but am paying out-of-pocket, will my insurance provider cover costs in the event of complications after surgery?
Post-operative complications are typically billed separately and your insurance company may not provide coverage for these costs. However, appealing their decision may yield some benefits. Contacting your hospital directly can also make a difference in your final expenses.
Will I have to go on a diet before my surgery?
Yes, you will need to stick to a specific diet prior to weight loss surgery to shrink the liver and reduce fat in the abdomen. This should start roughly 7 to 14 days before your procedure. Certain insurance companies may also require you to follow a physician-monitored diet three to six months before surgery as a condition of their coverage; however, unlike a pre-operative diet, this regimen is usually meant to prove a willingness to complete appointments, adopt a healthier lifestyle, and learn about food education.
Will I have to diet or exercise after weight loss surgery?
Yes, but perhaps not in the traditional sense.
Many people associate “dieting” with a restricted lifestyle that forces you to endure hunger for cosmetic purposes. In reality, a healthy diet after weight loss surgery simply means making more nutritious food choices. After surgery, patients typically do not feel hungry like they previously did. Their appetite is much smaller and easier to satisfy. Healthy foods are essential to achieving successful, long-lasting results, but patients can still enjoy occasional treats and tasty snacks. Your appetite will be limited at first, but some form of it should eventually return 6 to 18 months after surgery.
Some patients are also under the impression that exercise requires demanding and dreadful workouts. However, our doctors recommend more moderate activity that aligns with what you enjoy. We understand that when exercise feels punishing, patients are less likely to continue a healthy lifestyle. You can work with your surgeon to identify the programs and workouts that you prefer. While there are times when exercise will feel difficult, everyone has a different plan that works for them. Even people at a normal weight need exercise for stress and appetite control, as well as to avoid frail bones and muscle loss as they age. Expect to make mistakes and learn throughout your journey!
How do I get a letter of necessity?
A letter of necessity is a written document from your bariatric surgeon or primary care provider that details information about why it is medically necessary for you to undergo surgery. Some insurance companies require a letter of necessity to provide coverage, while others will simply accept your surgeon’s consultation summary note. We recommend asking your insurance provider directly what materials they will need to cover your surgery. Information your insurer may want to know often includes your current weight, your body mass index (BMI), your height, any medical issues related to your weight or obesity, and any history of past dieting.
How long should I plan to miss work after bariatric and metabolic surgery?
Patients can usually return to work approximately one to two weeks after their surgery, provided that their work is non-strenuous. We generally recommend easing back into your normal schedule by only working half-days or every other day for the first week. Some employers may want you to return to the workplace as soon as possible, even if you can’t perform all your normal duties right away. The most important thing is to listen to your body—you will likely have low energy for some time after your procedure, which can be dangerous in certain work settings.
Your health and safety—as well as the safety of others—is critical, so take care to avoid overextending yourself. Our doctors recommend only returning to work when you are free of pain, have stopped taking your pain medication, and feel energetic enough to resume your work responsibilities.
When can I start exercising after surgery?
Light activity can start soon after surgery. On the night of your procedure, our team will usually assist you in taking short, delicate walks. The best course of action is to start slow and move on to longer exercises as you assess how your body responds to each level of activity. You can begin swimming or soaking in water after your incisions are fully healed.
At what point can I get pregnant after metabolic and bariatric surgery? Will the baby be healthy?
Our doctors recommend waiting 16 to 24 months after your procedure to get pregnant. Most patients are much more fertile after their surgery, and it is not uncommon for menstrual periods to be very irregular. Since birth control pills can be unreliable while your weight is in fluctuation, it is typically best to have an IUD or use condoms and spermicide during all intercourse.
After metabolic or bariatric surgery, there is usually a decreased risk of problems during pregnancy (such as gestational diabetes, macrosomia, and eclampsia) and childbirth, as well as fewer instances of miscarriage or stillbirth when compared to heavy patients who have not undergone weight loss. The likelihood of needing a C-section is also reduced. Additionally, children born after surgery have a lesser risk of obesity in the future due to certain genes being activated during the growth of the fetus. For more information on this, please look up “epigenetics.”
With that said, many women who become pregnant after surgery tend to be older than the conventional age of pregnancy among their friends or loved ones. Having a child at an older age may increase the risk of certain issues, such as spinal deformities or Down’s syndrome. Your doctor will speak with you about this in more detail during your consultations.
Is plastic surgery necessary after weight loss surgery? Are these procedures covered by insurance?
Some patients may choose to undergo plastic surgery to remove excess skin after their procedure—if this is your choice, we recommend waiting at least 18 months before scheduling cosmetic surgery. In some cases, the presence of excess skin can be more temporary than expected. Remember, your appearance often changes significantly in the 6 to 18 months after surgery. Many individuals have some degree of sagging skin from their weight loss, but this often depends on your age, how much weight you lose, genetics, whether you smoke, and your lifestyle habits. Loose skin can often be concealed with clothing or compression garments, which can be bought online to help improve your appearance.
Plastic surgery to remove excess abdominal and/or breast skin may be covered by medical insurance if you have issues with perspiration, rashes, or general hygiene. Be sure to check with your insurance provider to learn the requirements for full or partial coverage. Unfortunately, procedures to smooth skin in the upper arms or other regions may not be applicable for coverage if they are deemed cosmetic in nature by your insurer. However, there are many medical spa treatments and less invasive procedures that are available, potentially making costs much more affordable.
Will I lose my hair after surgery?
Some hair loss is common three to six months after surgery for reasons not completely understood, but this is usually temporary and should not result in any long-term thinning. You can help encourage the regrowth of hair by taking the recommended amount of vitamins, proteins, and minerals.
Will I need to take vitamins and minerals after surgery? Are they covered by insurance?
After your procedure, you will need to take a multivitamin for life and may require higher doses of iron, calcium, vitamin D, and other minerals. Lab checks are also required at least every year. Insurance companies usually pay for lab fees, but often do not cover the cost of vitamins and minerals. For these expenses, you may be able to deduct the cost from a flexible spending account. Be sure to check with your insurance provider to learn the full scope of your benefits.
How can I exercise if I can’t walk?
There are activities that can count as moderate exercise for virtually everyone, even patients who are partially paralyzed or who struggle with arthritis or joint and spine pain. A physical therapist can help you determine which exercises will work for your needs. A requirement of our program is the ability to walk at least 100 feet, four times a day.
Can I stop taking some of my medications after surgery?
Following surgery, it is not uncommon for patients to reduce or even eliminate their need to take medications related to blood pressure, heart disease, diabetes, cholesterol, and/or arthritis. Your surgeon or doctor will advise you on this personally as you start to lose weight. If you plan to undergo gastric bypass surgery, gastric sleeve surgery, or a duodenal switch procedure, you may be able to decrease or discontinue your dosage of diabetes medication after your operation.
Candidacy For Surgery
Am I allowed to undergo laparoscopic surgery if I have a hernia, stoma, or previously had abdominal surgeries?
Generally speaking, yes. You and your bariatric surgeon and anesthesiologist will have a discussion about all of your prior procedures, particularly operations performed on the abdomen and pelvis. We will review your entire medical history, including any childhood operations, to determine whether it is safe for you to have laparoscopic surgery. Please be sure to disclose all information that may be relevant, as it is best to avoid surprises when possible.
In some cases, your surgeon may ask to review the operative report from any complex or specialized procedures, especially those performed on the stomach, bowels, or esophagus.
Is surgery riskier if you have Type 2 diabetes?
It can be, which is why it is essential to follow your surgeon’s instructions about how to manage your diabetes around the time of surgery. Most patients with Type 2 diabetes are able to safely undergo weight loss surgery and even see improvement in their condition, or complete remission, following their procedure. Studies have also reported that bariatric procedures can help patients with Type 1 diabetes.
Can I undergo laparoscopic surgery if I have heart disease?
Yes, but medical clearance from your cardiologist may be required before you have surgery. Patients who have previously had heart valve replacement, atrial fibrillation, placement of stents, or heart bypass surgery often do very well during laparoscopic procedures, but be sure to communicate any heart conditions you have to your surgeon and nurses. If you are on blood thinners, you will likely receive special pre- and post-operative instructions.
Bariatric surgery can improve many heart-related health conditions, including:
- High blood pressure
- High cholesterol
- Lipid problems
- Heart enlargement (dilated heart or abnormal thickening)
- Vascular (artery and vein) disease
- Coronary (artery) heart disease