Question:
DOES MEDCAID OR MEDICARE PAY FOR LAP BAND SURGERY?

I HAVE BEEN APPROVED FOR GASTRIC BYPASS SURGERY. BUT MY SISTER IS AN RN AN HAS BEEN FOR OVER 25 YRS. SHE DOES HOME HEALTH CARE FOR OUR LOCAL HOSPITL HERE IN N.C. SHE SAYS GBS IS VERY DANGEROUS!!!!!!!!!!!!!!!!!!!!!!!!! SHE HAS ALOT OF CLIENTS THAT HAS HAD THE SURGERY AND THEY HAVE AN HAVE HAD ALOT OF SERIOUS SET BACKS AFTER THE SURGERY.SO I HAVE DECIDED TO HAVE THE LAP BAND, BUT I NEED TO KNOW IF MEDICARE OR MEDCAID PAYS FOR LAP BAND? THANKS AN GOD BLESS! MY E-MAIL ADRESS IS [email protected]    — tootiefruitiesmoothi B. (posted on January 29, 2005)

January 29, 2005
Hi I understand Your concerns and it is up to You if You want RNY or not but unfortunatly I don't htink that they will pay for the band because they are not permanent fixes.I realize RNY isn't a fix but a tool but they see it as a fix. You do realize that RNY is no more dangerous than a hernia repair or gallbladder surgery or anything like that. I had all kinds of family and friends trying to scare me out of this pre op but now no complications and 70 lbs lighter they seem happy. And glad I did it. Best Wishes
   — Shell G

January 29, 2005
have been looking into lap band here in Tx. and was told it does cover it but each state is different. i TOO WAS GOING TO HAVE RNY IN South Carolina but problem occured and surgery was postponed after that I didn't go back. check the doctor in your area that does the surgerny and call them that what I DID.
   — DAWN P.

January 29, 2005
I do not think they cover it because it is kind of a half-fix. The initial results are not nearly as good as the RNY, and the percentage of weight regained is also much higher. Frankly,(and this is only my opinion), I wouldn't go through all the trouble and pain, for minimal results. Might as well go to Jenny Craig. I had RNY one month and eight days ago. I have lost 25 pounds with no complications (I believe, from what I have read, and once more let me clarify, only my opinion, that many of the people that have complications are in the super morbidly obese category, or have prior severe medical problems. Good luck in your choice. Linda JA Rodham
   — lindarodham6

January 29, 2005
I don't think your sister is wrong--the surgery is very risky. Have you looked at the memorial page on this site? Too scary. And just to clarify for others who have answered your post, the band is very effective. At the two year point the band catches up with bypass in terms of percentage of weight lost. Loss is slower with the band but much much safer--and noone can convince me that faster is better, healthier, or safer. Also, because the band is adjustable you always control your weight loss journey--there is no window of opportunity like with bypass. With bypass, when your pouches stretches out (and it often does over time) then it requires another surgery or revision to continue to lose or maintain--with the band if you pouch stretches, you have it unfilled, wait a few months, and continue on with your weight loss. Sorry I can't help with medicaid stuff. But I can say, just because you aren't covered doesn't mean you have to be pushed into a surgery you aren't comfortable with. There are many self pay options out there. good luck! Jessica
   — jessicamegan

January 30, 2005
Any surgery is risky, whether putting in a band or doing the RNY. You have to talk to your surgeon and ask LOTS of questions. The person that posted about the "window of opportunity" is somewhat misinformed. Yes the pouch will stretch over time, mine has hardly stretched at all and is almost the same size as when I had surgery. I do not overeat or abuse the tool I have. The RNY as we all know is effective, but if I were you, I would certainly examine your lifestyle and all the pro's and con's of the various surgeries that are available to you under Medicare or Medicaid and then make a decision. The RNY is not for everyone anymore than the Lap Band is. Good Luck!
   — [Deactivated Member]

January 30, 2005
I have to say that the consideration to have any surgery should not be entered into lightly. Every aspect sould be scrutinized very carefully. I can symphathize with you. Though I have not been a Nurse for 25 years, I am in a Bachelors Degree Nursing program, Well educated, Have had a full open RNY, Perform speeches on behalf of WLS to the medical community, and lost 123 pounds as a result of this tool. I would be lying if I said that RNY is easy, It is anything but easy. It is more restrictive, you can tolerate less sugars, you dump more often and on more foods. I was told by my Surgeon Dr. Sidney Rohrschieb, "If you dont want to be as restricted, have the banding", "If you want the restrictions that will lead to positive reinforcement and keep you for your poor eating pitfalls, then have the RNY". My surgeon does both, he feels from a technical standpoint that Lap Banding is much easier. Most times you can get out of the hospital in 24 hours as opposed to the 3 to 4 days with RNY. Recovery from the Lap banding is much quicker. With all off this in mind, what would someone in their right mind have the RNY?? Well because it works well. The Clinical Medical Data, in several Medical Journals, (New England Journal of Medicine) Supports the claim that RYN patient have the lesser rate of regaining weight 2-5 years post-op. I can only base my opinion on proven data. I have several local friends that have had the banding, one is unhappy because she can eat anything that she wants and is not losing, the other is happy that she isnt restricted (She is 10 months post op and has lost only 49 pounds.) I would have to say that it is all about what you are comfortable with, not what everyone else thinks. Which suits your life better? As for the Banding, Medicaid/Medicare will not pay for the banding no matter the state you live in. I can send you a PDF of Medicare's regulation and coverage for the 2005 fiscal year. I will tell you that medicaid closely follows any dictates that medicare hands down. (I work in a Nursing home part time while in school and have access medicare regulations because we have a medicade wing.) You have to go with your gut, what is right for you, you have to be able to be ok with what you choose, it is not about me, I have already made my choice, not about anyone else, again they already made their choice. I wish you the best luck, I hope that you get to the healthy you that has been there all a long. I know that you are a winner and that you will come out on top with what every you choose. Christy Age 34 5'2" 264 start/123lb.Gone/ 141 delightful pounds/ 15 pounds until goal!!!
   — Tiny Pixie

January 30, 2005
Finally, someone I can relate to. If you get an answer to this question, let me know....I too have opted for the lap-band surgery and I have Medicaid. I can't find a doctor that will do it. I have been through the doctor lists on this site and called everyone I can think of to see if they know and I still can't find out. I have been wanting WLS for so long and I am feeling so frustrated that I can't get the one I want. And I would hate to have the RNY just because I couldn't have the lap band. Let me know if you get an answer. Good luck to us both!!
   — Debbie B.