I am 23 years old, about 5’1 and weigh 196 pounds. I know there are a lot of different things they look at to be approved for this kind of surgery, but looking at my weight, height and age, does it seem like I may qualify just for that? I don’t really have any health problems, except for a lot of back aches, mostly when I’m laying down I think because of the pressure of my weight on my body. And my knees bother me quite often. And in your opinion, do you think lap band surgery or gastric bypass is better and why? And would Medicaid pay for this? I have heard many different things, like they will or won’t pay for it, so would like to hear from people who have gone through this. Just getting some information on this and would like as much advice as possible. Thanks in advance.
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Medicaid coverage of these kind of surgeries usually varies state by state. In each state that allows this, it is a very difficult and long process. Medicaid will only approve it when you reach what they call ‘medical necessity’. Back aches are not enough. They look at things like, high blood pressure, diabetes, liver, mobility etc. People usually get this type of surgery only with BMI’s over 40 also most doctors make the person loose some 20 lbs on their own before they sign off on it.
Also, at 23 you probably do not qualify for Medicaid unless you are preg, disabled. It’s not just for everyone with a low income.
First with your given conditions there are many doctors that would give you this surgery if you paid out of pocket. But under Medicaid you do not qualify. You would have to another condition associated with obesity such as diabetes or hypertension or something. The problem as well with medicaid paying for weight loss surgeries there is usually a 3 or 4 year weight list because as one of the other people said they are short on funds. Your BMI is 37 which means you are in the obese stage but most good doctors do not want to give a gastric bypass to someone under a 40 BMI (body mass index). You would be more of a candidate for a Lap Band which is less intensive than the Gastric Bypass but works just as well.
Gastric bypass and Lap Band both have their distinct advantages and disadvantages and there is alot more information to consider before telling you if one is better than the other for you. I would suggest that you find a weight loss surgery seminar in your area they are free to go to and have TONS of information that will answer all of your questions.
Alternatively you can also check out my blog for more information on the different weight loss surgeries out there.
Personally I had the gastric sleeve 2 months ago almost and I feel great. I have lost 54 pounds and counting. BUt you need to do alot more research before you were to have any surgery.
Good luck
I do know several people who had this surgery with Medicaid insurance, but believe it will vary from state to state. I don’t believe they would approve that surgery for you because you are just not obese enough with multiple health problems from being overweight. They only approve the most serious cases with being morbidly obese from what I understand. Other insurances are usually the same way. I agree with this since it should be the last resort for morbidly obese people. A lot of people want to have it done for the wrong reasons and have very little understanding of what it means to get this life changing surgery.
I don’t know if Medicaid covers weight loss surgery – either the lap band or the gastric bypass. You need to contact someone and find out for sure – and made sure you have it in black and white. Don’t take anyone’s word for it. Now, at 5’1" and 196 lbs, your BMI is 37, which makes you obese. Generally you have to have a BMI of 40 or more to have gastric bypass surgery, or a BMI of 35 or more with significant comorbid conditions such as diabetes or obstructive sleep apnea. The lap band can sometimes be done with a BMI of 35 or more. Sometimes this depends on the surgeon and sometimes on the insurance that is paying for it.
What you need to know about either surgery is this: Both are PERMANENT, NON- REVERSIBLE surgeries. Both can be done laparoscopically, and the gastric bypass is a bit more complicated than the band, but both come with risks. They are by no means a quick fix and you will have to be prepared to change your lifestyle and eating habits for either one to work. You will lose weight at first with either procedure, but if you don’t change your ways when you have surgery, you will regain the weight. And why go through the whole process if you aren’t going to make the most of it? Most surgeons have you go through a psychological evaluation to make sure you are ready to make the changes, some require a sleep study, many require you to attend classes before surgery to make sure you know how to eat and care for yourself after surgery. Some want you to be on a strict diet for weeks to months or lose some weight before they will do the surgery. It really differs from one surgeon to another.Some don’t require much at all. Just be prepared to "jump through hoops" to get to the point of actually having surgery.
By the way, I’ve never come across anyone who has replaced eating with a destructive habit. The majority have had the surgery in order to become healthy, slimmer people and tend to be better about actually exercising and eating right and taking care of their bodies, so why mess that up?
You can lose weight though hard work -dieting and exercise, but I had gotten to the point I had tried every diet, exercised and just had no other options. I had to decide if I was willing to possibly risk my life by having surgery, or risk an early death by continuing to gain weight (or stay where I was). It took me about a year to come to the decision to have weight loss surgery.
Also, I was on metformin 1500mg every day for insulin resistance before surgery. My poor old pancreas was pumping out the insulin like crazy but it wasn’t getting into the cells. I had to stop the medication right before surgery, but never needed to go back on it. It is not an unexplained mystery that often diabetes disappears after weight loss surgery! The same thing can happen if a person loses weight through diet and exercise! The only difference is, the weight loss after surgery is pretty fast – most of it within the 6-9 months after surgery, where it can take years to lose it through diet and exercise. Oh, and saggy skin after surgery – it makes no difference if you lose weight slowly or quickly – if you skin is still elastic, it will recover. Older people and people who carry a couple of hundred extra pounds or who just have genetic predisposition to saggy skin, will have it no matter what. Having surgery to correct that afterwords is a personal choice. Some people are really bothered by a small amount of saggy skin, others have tons of it and aren’t concerned about it because they are more focused on having a lighter, smaller body!
The biggest problem with the surgery is that it seems to have some rebound effects. Many people replace their ‘eating’ with another destructive activity.
Many people report that their diabetes completely disappears after the bypass. That is one of the unexplained benefits.
You do want to exercise and eat right rather than subject your body to an operation that can cripple or kill you ( altho it is 99% safe).
Medicaid is so short of funds that it can’t be relied on.