Due to its potential for complications, the insurance companies generally
require doctors and patients to jump through a series of proverbial hoops in
order to validate coverage, about 9 months worth of hoops, in most cases.
First, the prospective patient must fall into most of the following
categories:
Have a body mass index of 40 or more, or be overweight at least 100 pounds
Have a serious, life threatening or debilitating illness related to
excessive obesity (i.e. high blood pressure, high cholesterol, heart condition,
diabetes, etc.)
Have a family history of heart problems, high blood pressure, diabetes, or
high cholesterol, including parents who died early as a result of one of these
conditions
Have been obese for a minimum of 5 years
Be between the ages of 18 and 65
Not have a history of alcohol abuse, depression, or other major
psychiatric disorder
The surgery is a serious one that could result in complications. So, it’s
vital that the patient know what he or she is getting into. The second hoop
they must jump through is a psychiatric evaluation, which discovers their
motivation for dropping the weight – whether it is one of vanity or survival.
It may also address the patient’s attraction to food, and determine whether
there is an underlying emotional disorder or a history of abuse that causes
them to eat.
In addition to a psychological evaluation, many insurance companies require
group therapy. During group therapy, patients get to meet each other and see
how other patients deal with their situations. There are a variety of patients
present during these sessions – everyone from 260 pounds on up to those who
cannot function without the use of a wheelchair. It is an extremely emotional
environment, in which people share their deepest hurts related to being
overweight, and the factors that caused them to become clinically obese.
Doctors may also require proof from the patient that they’ve made several
attempts to lose weight. This may mean keeping a journal for several months, or
attending weight loss groups such as Weight Watchers or Jenny Craig. Usually,
this also means discussing your weight issues with your physician long before
you ever mention gastric bypass surgery.
In addition to the psychological aspect, the physician is required to
evaluate the patient’s medical history. They must perform upper and lower GIs
to be sure that the patient is relatively healthy in other aspects besides high
blood pressure, high cholesterol or diabetes.