Expert: John Pilcher, MD - 5/31/2007

Question
I am 58, 6’0”, and weigh about 230.  I’ve tried eating less and exercise to lose weight for years with no success.  I would like to try lap band surgery.  I don’t believe I would qualify for insurance reimbursement.  I’ve heard that overseas procedures, such as in India cost about 25% as much as having it done in the USA.  How can I determine the best place to have the procedure done where I will get good quality care at the lowest possible cost?


Answer
Roger,
The information you've provided works out to a Body Mass Index (BMI) = 31, so I believe you are correct that insurance is unlikely to cover placement of a Lap-Band in your case.  It is also true that having a BMI > 30 is very likely to create or exacerbate medical problems in your case, so it is quite possible that Lap-Band placement is reasonable on medical grounds, in spite of your weight not meeting standard insurance criteria.

I presume you are asking about overseas surgical programs because you are trying to find the lowest cost possible, and this is also reasonable.  At the end of my reply I am going to share some concerns with you about travelling outside your own country to have Band surgery, but first I will give you my best possible direct answer to your question.

You are most likely to find an excellent  surgeon by seeking one who is experienced and who is committed to long term surgical therapy of obesity.  Some specific features of such a surgeon would likely include:
-personal case history of more than 300 cases
-ongoing conduct of more than 100 cases per year
-support program includes dietician, psych, exercise, and support groups
-Member of American Society for Bariatric Surgery (most leading international surgeons are members of the ASBS), or International Federation for Obesity Surgery

Now I need to share several areas of concern with you:

Although I have met OUTSTANDING surgeons wherever I have have traveled, it also tends to be the case that medical care overall is more variable outside the US, especially in countries where you are likely to save a lot of money.  Please recognize that your outcome depends not only on the surgeon, but also anesthesiologist, nursing staff, etc.

More importantly, it turns out to be impractical to get the Band correctly adjusted when one has to travel more than about 2 hours for a clinic appointment.  Band fill protocols vary, but most patients need 5-8 episodes of Band adjustment to get the Band "tuned" to work properly for them.  The Band adjustment and follow-up process is clearly best done by the surgeon placing the Band, so that when you add the cost and time of follow up visits to the equation, the cost savings start to fade quickly.

Thus I would encourage you to seek a surgeon as close to home as you can find.  The best surgeon locator is on the ASBS website at:

www.asbs.org

Best of luck!
DrJP