Question
What is the name of your state?CA
HELLO
ARE HMO REQUIRES THE PERSON WANTING BARIATRIC SURGERY TO LOSE 10%, OF THEIR WEIGHT (PRE OP), EVEN THOUGH CA. DEPT OF MANAGED HEALTH CARE THAT OVER SEE'S CA. HMO'S HAS A SECTION DEVOTED TO PRE-OP WEIGHT LOST.California Department of Managed Health Care provided a number of discussion points, which are addressed throughout the following narrative summary.
Summary Conclusion
There is no literature presented by any authority that mandated weight loss, once a patient has been identified as a candidate for bariatric surgery, is indicated. There is a mixture of results that question whether weight or truncal obesity is a risk factor for complications after bariatric surgery.
Mandated weight loss prior to indicated bariatric surgery is without evidence-based support.
Mandated weight loss prior to indicated bariatric surgery leaves the patient at increased risk from the patient's comorbidities
Mandated weight loss prior to indicated bariatric surgery is not medically necessary.
Mandated weight loss prior to indicated bariatric surgery would be deviant from the standard of care practiced in the United States and other published countries. The National Institutes of Health (NIH) published a Consensus Paper regarding "Gastrointestinal Surgery for Severe Obesity" in 1991. These guidelines were updated in 1996. Other guidelines for the treatment of the morbidly obese include the National Institutes of Health, National Heart,
Lung and Blood Institute, Mun, Fisher, and the America Gastroenterological Society. These guidelines provide consensus information regarding the care of the morbidly obese, including surgery.
The guidelines agree that once supervised weight loss has failed, the patient is appropriate for surgery if mentally stable and there are no other etiologic factors. No guideline mentions, cites, or recommends mandated weight loss prior to bariatric surgery. Thus, it is not that the guidelines are silent on the matter of preoperative care, but that they do not recommend any weight loss prior to bariatric surgery once the patient is deemed as meeting the criteria as one who would benefit from the surgery.
Factors Predictive of Complications
Lancet in 2003. The interpretation of their study is stated as, "Obesity alone is not a risk factor for postoperative complications.
Pennsylvania state discharge database was utilized to identify 4685 cases of gastric bypass surgery for obesity between 1999 and 2001 This retrospective study found complications did not correlate with any preoperative parameter measured.
Liu at UCLA, used the California inpatient discharge database. All gastric bypass operations from 1996 to 2000 were identified.This study identifies three independent predictors of complications: gender, comorbidity and hospital volume."
The risks of delaying bariatric surgery, while not entirely known in the short-term, are real and can be measured.
Lglezias and others present evidence that rapid weight loss may increase the risk of cholelithiasis.Prolonged hospital stay, fasting, and other conditions are known to increase the risk of cholelithiasis. Thus, there is some concern in the literature that rapid weight loss, possibly interpreted to include mandated weight loss so that one could receive bariatric surgery, has complications.
In the Swedish Obese Subjects (SOS) study Torgerson presented data demonstrating that surgical subjects showed a definitive decrease in hypertension and diabetes while such decrease was notevident in the non-surgical group.
I ALSO HAVE DOCUATION SHOWING ARE HMO NOT REQUIRING OTHER MEMBERS TO LOSE WT.
RIGHT / WRONG THANK YOU ED
Answer
Unless it violates your states regs they can set their rules.
And unless you have the complete and accurate medical records of "others" you can prove nothing!
Let's just say your assumption is correct then why have they "got it in for" you?
And all caps is very difficult to read.
Answer
Thank You for your input, will not use caps.
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I think what you need to look for are current medical standards of care. Health insurance plans requiring a 10% weight reduction is quite common and standard at this point in time. You need to remember, recall, read in your plan, whatever, that are are several points about health insurance worth remembering:
no employer is required to provide you insurance at all
once provided, there are few federal requirements as to what is covered by a plan, state and federal guidelines may differ, but the fact remains that there is little manadated coverage, if a plan is offered, and then one needs to determine if federal or state guidelines prevail, (near sure bet federal will)
So, most plans will define medical necessity (please read your plan). Most plans could care less about preventative care (a simple fact, but I personally disagree). Take the focus off preventative care and focus on any co-morbid conditions that you may currently have. I will list several:
uncontrolled hypertension
orthopedic conditions (degenerative osteoarthritis)
brittle diabetes mellitus
congestive heart failure (or any severe cardiac disease)
uncontrolled hyperlipidemia (high cholesterol and triglycerides)
others
Most plans will also require that you provide evidence of failed attempts of weight loss through physician assisted programs.
Do all of these things, keep records, document, document, document and you will likely eventually qualify for weight reduction surgery. (Read the definitions of morbid obesity etc. as well.) lkc15507
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Hello 1kc15507,
Thank You, for replying. By any chance would you know it the states department of managed health care actually have authority to over ride hmo's? Thanks again Tom