Welcome to Surgically Slim, the online newsletter published by The Mount Sinai
Program for Weight Loss Surgery.
OBTAINING INSURANCE APPROVAL
You
think weight loss surgery may be the answer for you. But you need help paying
for the procedure.
Fortunately,
many insurance companies cover weight loss surgery. These procedures are not
cosmetic—they treat a life-threatening medical condition.
But
obtaining coverage requires you to follow very particular rules. This article
offers a general guideline of what to expect.
- First, you need to determine whether your
health insurance covers weight loss surgery. Check the “certificate of
coverage” or “summary plan definition” for your health plan. Your employer’s
human resources department should have this information. You can also get this
document directly from the insurance company.
The
certificate of coverage lists what types of services the plan does and does not
cover. Insurance companies may approve some types of weight loss surgery and
deny others, such as the duodenal switch, as experimental. When asking about
coverage, specify the type of procedure you are interested in.
You can also call your insurance company to find out if your
plan covers weight loss surgery and, if so, which types.
-
If you pass this
important test, remember this cardinal rule of insurance approval: keep
records of everything. This includes receipts for programs like Weight
Watchers and Jenny Craig, as well as fitness-club memberships. You need to
bring this information to your primary-care physician, who must document your
participation in these programs.
Most insurance companies require six months of medically
supervised weight loss before they will approve weight loss surgery. Check with
your carrier for its specific policy.
-
Next, organize your
medical records. In addition to the receipts described above, make a list
of all other efforts to lose weight: diets, exercise classes, medication,
hypnosis, etc. Your primary-care physician needs this information to write a
“letter of medical necessity.”
-
Consult a weight loss
surgeon. You need to choose a
surgeon and a program you trust to give you the best possible care. An
experienced office, such as the Mount Sinai Program for Weight Loss Surgery,
will also help you gather additional information for the letter of medical
necessity, such as:
-
Your height, weight history and body mass index (BMI). The
National Institutes of Health (NIH) requires surgery candidates to have a BMI
of at least 40. Individuals with two obesity-related health conditions, such as
diabetes or high blood pressure, may qualify for surgery with a BMI of at least
35.
Receiving insurance approval for weight loss surgery can be
a long, involved process. But an experienced weight loss center can help guide
you through this process.
Call Dorothy Lee today at (212) 241-5339 to schedule an
appointment with one of our surgeons.
STARTING AN EXERCISE PROGRAM
It
can be hard to start a fitness program, no matter what your size. Very large
people have special challenges in becoming more active.
You
may not be able to move the same way as other people, or you may have problems
finding clothes that fit. Or you may simply feel self-conscious being active
around other people.
Overcoming
these obstacles will be difficult—but it can be done.
Just
remember to appreciate yourself. Focus on what you can do; don’t worry about
what you can’t do. Congratulate yourself for making the decision to become more
active. And celebrate your progress.
Regardless
of your size, you can choose from a variety of physical activities:
-
Weight-bearing,
such as walking, in which you lift your body weight.
-
Non-weight-bearing,
like swimming and water workouts, which put less stress on the joints because
you do not lift your own weight.
-
Lifestyle
activities, such as gardening, which do not require planning.
Find
activities that you enjoy. Maybe it’s golfing, dancing or bicycling. If
you like the activity, you’ll see it as a reward—not as a chore.
Start
small. It’s hard to walk a mile if you’re not used to physical
activity. Begin by walking for five minutes a day. When you feel tired, rest.
Tomorrow, try to beat today’s workout. Set small goals. And pat yourself on the
back as you pass your personal milestones.
Any
increase in your physical activity—even a few minutes each day—will help you
become healthier.
Speak
to your health-care provider about the safest way to increase your activity
level.
For more information, contact the
Weight-control Information Network (WIN), a service of the National Institute
of Diabetes and Digestive and Kidney Diseases of the National Institutes of
Health (win.niddk.nih.gov).
AHA WEBSITE OFFERS DELICIOUS DECISIONS
Diet
doesn’t have to be a four-letter word. Choosing healthy foods can still be
delicious.
Need
convincing? Check out Delicious Decisions (www.deliciousdecisions.org), a
website sponsored by the American Heart Association (AHA).
This
online resource features information on eating a well-balanced diet, including
tips for shopping and stocking your kitchen. It also offers a wide selection of
healthy recipes you can try at home, as well as advice on how to make smart
food choices when eating out.
The
website even includes tips on how to manage snack attacks. Craving something
sweet? Have some raisins or a small slice of angel food cake. Looking for a
mid-day munchie? Try part-skim mozzarella or a handful of nuts.
Now,
you can check out recipes from the AHA’s newest cookbook, The New American Heart Association Cookbook, 7th edition, for free.
Sample recipes include chocolate crème brûlée and artichoke-tomato pizza, both
at just around 200 calories per serving.
SPOTLIGHT ON SUCCESS: CHRIS L.
In
2005, 29-year-old Chris L. weighed 315 pounds. He had been obese for more than
20 years. He watched his grandmother die from diabetes. He saw how obesity
affected other family members.
Finally,
he decided to have weight loss surgery.
He
entered the Mount Sinai Program for Surgical Weight Loss in January 2005 and
started his journey to a healthier lifestyle. Already, Chris has lost 75
pounds. His waistline has decreased 15 inches. His high blood pressure has
disappeared. And his energy levels have increased.
“I
feel like ‘me’ is starting to come back to life,” says Chris. “I’ve reset my
body, given myself what I’ve needed. I love my new stomach, getting full
quickly and leaving food behind, eating healthier, being healthier and finally having enough energy to keep up with my
life.”
For
more than 20 years, Chris experienced only moderate success with weight loss,
never losing more than 40 to 45 pounds.
“And
I tried—I mean, I really tried hard to lose the weight,” he says. “Dr. Herron
and his team clearly gave me the missing link—the missing tools to becoming a
healthier person.”
Chris
credits his success to the comprehensive Mount Sinai
program.
“The
professionals at the program are so caring and detailed,” says Chris. “They want
you to succeed and are rooting for you every step of the way. I’m so thankful
to all of them. The one unexpected side effect from the program was I now have
hope—hope and faith that I will continue to succeed in becoming healthier."
© Copyright 2005 by Mount Sinai School of Medicine. All rights reserved.
