The Life Shape Program

Introduction
Components of our program
Recovery after surgery
10 Golden rules after Lap-Band
Insurance issues and Financing

Introduction

Life Shape is a multidisciplinary surgical weight loss program that offers the Laparoscopic Adjustable Gastric Band (Lap-Band). Our mission is to improve the health of our patients by performing the Lap-Band surgery with the highest degree of safety possible, and to maximize weight loss results with a comprehensive long term multidisciplinary weight loss program.

Components of our program

Our first goal is to provide patients with the information they need to see if the Lap-Band is right for them. To achieve this goal we provide patients with an information packet about the Lap-Band. We ask that patients attend one of our patient information seminars. The seminar includes the opportunity to meet some of our former patients.

Click here to see the schedule of upcoming patient information seminars.

When patients decide upon the Lap-Band, the next step is a medical evaluation to determine suitability for Lap-Band surgery. This is done in conjunction with the patients regular medical doctor. For those who choose to seek insurance approval for Lap-Band surgery, we will help by reviewing the patient's insurance company requirements for Lap-Band surgery approval, and preparing a letter of medical necessity. Subsequent to insurance approval, or when patients have decided to self fund the procedure, a consultation with Dr. Fusco will be scheduled. During this visit the surgery and program will be reviewed and any further questions will be answered. Any additional tests that Dr. Fusco feels are necessary will subsequently be scheduled and upon their completion, surgery can be scheduled.

During the week prior to surgery all our patients undergo a preoperative anesthesia assessment. This is done at Melbourne Same Day Surgery Center, with a member of the Brevard Anesthesia Group. We use this group exclusively for our Lap-Band patients so they have increased familiarity with the surgery.

The surgery is done as an outpatient at Melbourne Same Day Surgery Center. The surgery lasts from 1.5 to 3 hours. After surgery, patients will be up out of bed walking within a few hours. This is very important for recovery. Early ambulation (walking) decreases a variety of risks associated with the surgery. Patients should expect to be at the surgery center for several hours after surgery. After discharge some patients may be required to sleep the first night at Sea Pines Rehabilitation Center. This overnight observation is primarily for our patients who have a risk of sleep apnea. If the overnight stay is required this will be arranged after the anesthesia visit.

On the day after surgery, patients may be scheduled for an X-ray to check the position of the band.

Recovery After Surgery

Activity after surgery is "as tolerated". The average patient can do light activity immediately with more vigorous activity in one to two weeks. There is no forced limitation on activity, but patients should use their body as a guide and only engage in activities that do not cause discomfort. Patients typically take one to two weeks off from work.

For the first three weeks, patients are asked to take a diet that is designed to prevent distention of the pouch. The next three weeks involves a transition to the ultimate post band diet. Patients should be on the post band diet by the six week point. At that point, the patients first band adjustment is done.

10 Golden Rules to follow after Lap-Band surgery
(Key behavioral changes for success)

1. Eat only 3 meals per day
   
2. Eat slowly and chew thoroughly ( 15 to 20x per bite)
   
3. Stop eating as soon as you feel full
   
4. Do not drink while you are eating
   
5. No between meal snacks
   
6. Eat only good quality food
   
7. Avoid fibrous food
   
8. Drink enough fluids during the day (not at meal time)
   
9. Drink only low cal liquids
   
10. Exercise at least 30 minutes a day
    

At Life Shape, we are committed to help you negotiate the complex process of obtaining insurance approval for your weight loss surgery.

Insurance Verification
To determine if your insurance policy covers obesity (or "bariatric") surgery, refer to the policy package that all insured people receive after they have paid their first premium, or received the policy package offered by their employer. Typically, there are two sections that describe the extent and limits of coverage. The first is usually called "What Is Covered" or "Covered Expenses." These are the healthcare benefits for which the company will pay. The other section is "What Is Not Covered" or "When the Plan Does Not Pay Benefits." In this section, the company tells the insured which treatments they have to pay for themselves. You should refer to your insurance information to determine whether your policy covers surgical therapy for the treatment of morbid obesity.

Some policies will outright exclude bariatric surgeries. For instance, Medicare, Medicaid, and Tricare do not pay for the Lap-Band.

Others may have certain parameters for which bariatric procedures they cover and how much of the costs they cover.

Below is a partial list of companies that cover LAP-BAND® System surgery in Florida. To date, no company has paid the total cost of the program so all patients will have some amount of out of pocket expense.

First Health - Mail Handlers
United
United Harris Corporation
Aetna (only for patients that are thought to be to high risk for gastric bypass)
Cigna
A small number of Blue Cross policies. (Not Blue Cross of Florida - check your policies)

Submission Requirements
A Letter of Medical Necessity and weigh-loss history are necessary to obtain prior authorization for obesity surgery. A Letter of Medical Necessity states why significant weight loss is medically necessary for a patient and usually includes the following information:

• Patient's weight (which should be 100 pounds or more above ideal weight or a BMI more than 40 or more than 35 with associated medical problems to qualify)
  
• List of medical problems associated with obesity, such as type 2 diabetes, sleep apnea, hypertension, etc.
  
• Number of years patient has been overweight (which should be at least five or more)
  
• Number and types of failed weight-loss programs attempted in the past

If you create a document or packet listing all your weight-loss attempts (self-controlled or medically supervised) and their results, you can substantially increase your chances of getting insurance coverage for the LAP-BAND procedure. You should include any commercial diets or medical records of your weight-loss efforts. Contact us and we can assist you in preparing these documents.

Appeals
If weight loss surgery is specifically excluded from your insurance contract (see above) then there is little recourse other than changing insurance companies. This is a very risky maneuver because there is no guarantee that your new insurance company will cover your surgery. If weight loss surgery is not excluded by contract, but initial authorization is denied then each company has an appeals processes that can be initiated. There are a limited number of appeals, however, so this process should be undertaken with care. We recommend you consider enlisting the assistance of an attorney for your appeals. We recommend The Obesity Law & Advocacy Center.

The Obesity Law & Advocacy Center is a full-service private law firm devoted to representing morbidly obese persons in a variety of legal matters. The firm handles all types of civil litigation with an emphasis in appeal and grievance proceedings challenging the denial of medically necessary treatment for obesity and morbid obesity. They can be reached at www.obesitylaw.com

Patient Financing
When insurance reimbursement is not available, patient financing is another alternative you may consider. Since we are an outpatient based program, and the cost of surgery at an outpatient center is considerably less than surgery at a hospital, we can offer Lap-Band surgery for considerably less than many other programs. In many cases the cost of Lap-Band surgery in our program is half of what is typically charged for the gastric bypass procedure. Individual costs vary depending on your specific needs. Please contact our business manager Lynne Stoldt for assistance with self funding and financing.