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Insurance no help

Two surgeries can help morbidly obese people lose the weight and reduce their need for diabetic medicine, but are not covered by insurance companies.

The problem of insurance coverage for such surgeries is that most insurance carriers do not cover the cost of them, including the insurance company the Pearl River County Board of Supervisors recently approved switching to, BlueCross BlueSheild. United Health Care, the insurance company the board of supervisors is changing from, does cover the cost of Gastric Bypass surgery, Dr. Alfred B. Johnson said. However County Supervisor Adrain Lumpkin said United Health Care does not cover the procedure. United Health Care does not have public relations representatives to comment on their coverage over the phone.

Johnson is the first surgeon to provide Bariatric surgeries, which include gastric bypass and lapband operations. Johnson said he performs them via a laproscopic procedure involving a small incision, small tools and a camera as opposed to the more invasive open procedure where a large incision is made in the abdominal cavity.

Gastric bypass surgery involves making a walnut size pouch out of the top of the existing stomach and connecting the small intestine to that pouch. This process bypasses the large intestine and most of the stomach, thereby limiting the amount of food that is eaten and digested, Johnson said. Lap band surgery applies a band around the stomach, which limits the amount of food a person can eat. The laproscopic approach for both has a faster recovery rate.

“Laproscopic as opposed to open is definitely a shorter stay (in the hospital),” Johnson said.

Before any patient considers entering into either surgery they have usually exhausted all other avenues of losing weight, such as proper diet and exercise, Johnson said. He estimates that 95 percent of obese people who try to lose weight via exercise and proper diet do not lose weight and instead gain more.

About 65 percent of the American population is overweight, with 12 to 15 million people who are considered morbidly obese. Johnson said this problem is due to the American culture of availability of fast food, sedentary lifestyles, learned eating habits and genetic dispositions.

Johnson practiced in Atlanta, Ga. for the past five years and has performed about 500 of the procedures, and has only lost one patient, he said. The mortality rate is about 1.5 percent for gastric bypass surgery, according to http://www.webmd.com/diet/Weight-Loss-Surgery/Gastric-bypass. There is, on average, a two percent rate of complications such as digestive leaks, blood clots in the legs and pulmonary embolisms, Johnson said. The site also lists that about 30 percent experience iron and vitamin B12 deficiencies, but those can be treated with vitamin supplements.

Meetings with dietitians and counselors is required pre-surgery, Johnson said, not post surgery as stated by BlueCross BlueSheild representatives at a past board of supervisors meeting. Any medical care required post surgery is covered by the initial cost of having the procedure performed, he said.

Post surgery Johnson said he sees his patients two weeks, six weeks, three months and six months after the procedure is performed.

“It’s just a matter of routine follow up to make sure the patient is on the right path,” Johnson said.

The surgery has proven to be especially beneficial to obese patients suffering from type II diabetes. In some cases where diabetes patients previously had to take two or three medications a day, gastric bypass surgery could help them come off all of their medications. That medicine cost would save the insurance company a lot of money over time, Johnson said.

Obese patients who previously suffered from sleep apnea, hypertension, high cholesterol and joint and back pain all also improve after bariatric surgeries.

Whether the patient’s insurance company will cover the cost of the procedure varies from company to company and state to state. In Atlanta BlueCross BlueSheild covered the cost of the procedure since they were backed by an HMO, but here in Mississippi, BlueCross BlueSheild will not cover the surgery, Johnson said.

So far he has noticed that state employees, such as teachers, have no insurance coverage for bariatric surgeries.

The average cost for a gastric bypass surgery is about $17,000 and the lap band surgery would cost about $13,500. Those are cash prices and cover all medical and hospital costs. Insurance companies would be charged slightly more.

Johnson said he holds monthly weight loss seminars at the library for anyone who is interested.