Bariatric Surgery/coverage

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Expert: - 7/21/2007


Question
I am interested in having surgery to make my body smaller.
Either lap band, gastric bypass, or another.  I have heard that medicare will cover some and what they do not my medicaid will cover.  I am wondering if this is true before I even get my hopes up on having the surgery.

Answer
Dana,
Medicare does cover Lap-Band, gastric bypass, and duodenal switch for patients who meet the criteria.  Unfortunately, the criteria vary a bit by region so you will need to confirm the details with a surgical program, but the basic requirements are:
-Body Mass Index > 35
-patient suffers from a weight related medical problem
-patient has truly tried to lose weight without surgery
-only covered when surgery is done at a certified Center of Excellence

I can't speak for Medicaid coverage, since that varies by state.

The best way to determine if you are covered is to contact the surgical program that is closest to you, that is also a Center of Excellence.  You can find programs like this on the web at the website for bariatric surgeons:
www.asbs.org

Best of Luck!
John Pilcher, MD

Bariatric Surgery

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Volunteer

John Pilcher, MD

Expertise

I can answer medically oriented questions about bariatric surgery including: patient selection, preparation for surgery, differences between types of bariatric surgery, aftercare following bariatric surgery. I can answer detailed questions about gastric bypass, Lap-Band, gastric sleeve, and revision bariatric surgery. I am only somewhat familiar with Biliopancreatic diversion. I am not prepared to answer insurance or other financial questions related to bariatric surgery.

Experience

I have been a practicing bariatric surgeon since 1995. About 85% of my current practice consists of bariatric surgery, including all of the above procedures except biliopancreatic diversion. I am the senior surgeon of a 5-surgeon group. I am recognized among surgeons and other medical professionals as the most experienced bariatric surgeon in my region.

Organizations
Fellow of American College of Surgeons Member, American Society for Bariatric Surgery

Education/Credentials
BA in Biochemistry - University of Virginia Medical Degree - University of Virginia Surgical Residency - University of Virginia

Awards and Honors
Alpha Omega Alpha

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