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Does Medicare Cover a Gastric Bypass Revision

Does Medicare Cover a Gastric Bypass Revision?

Gastric bypass is a form of bariatric surgery that has a strong track record of helping patients lose weight and keep it off long term. With that said, sometimes, it doesn’t take the first time, or there are other issues that require a revision. If you have Medicare coverage and might require revision, it is important that you understand what your benefits will cover. Revision bariatric surgery insurance coverage can vary.

Weight Gain After Bypass

After getting a Roux-en-Y in Maryland, you should experience weight loss that will speed up, slow down, and plateau at various times until you reach your ideal weight—assuming you are maintaining a proper diet and exercise routine. However, the occasional patient will only experience initial weight loss, then begin gaining again. An even smaller percentage never lose weight at all. When a patient gains weight after gastric bypass surgery, it is important that their doctor ascertains the reason this is occurring. This will not only determine what the next steps are, but also might impact whether or not Medicare will pay for gastric bypass revision.

Potential Causes of Post-Bypass Weight Gain

  • Enlarged Stoma: This is the opening between the stomach and the intestines. Gastric bypass not only creates a smaller stomach, but should also make the stoma smaller, making it harder for food to pass through.
  • Too Much Absorption: Another aspect to the function of a bypass is malabsorption of calories. If this is not sufficient, you will continue to take in excessive calories and gain weight.
  • Large Pouch: If your stomach pouch isn’t made small enough, it will be able to accommodate too much food, allowing food to be stored for longer and the calories absorbed.
  • Gastro Fistula: With this, a fissure develops that allows the stomach and intestine to connect outside of the surgical bypass.
  • Poor Lifestyle: Out of all the options, this is the most common. If you do not eat healthier, portion control, and exercise regularly, you will gain weight.

Does Medicare Pay for Gastric Bypass Revision?

Generally speaking, Medicare does cover gastric bypass revision when it is deemed medically necessary. However, this requires documentation supporting surgery as the solution. If your weight gain is related to a poor lifestyle, you are more likely to have coverage of bariatric revision surgery in Baltimore denied. Medicare typically will require you to seek behavioral health services to modify your behaviors and make better choices instead of covering revision, or at least mandating this as a step to getting coverage. If you are considering gastric bypass or revision surgery, work with the top-rated bariatric surgeons in Maryland. Call Ascension Saint Agnes Bariatric Surgery to schedule your consultation.

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