by Susan Gallagher Camden, RN, MSN, WCON, PhD; and Anita Houle

Susan Gallagher Camden, PhD, RN, MA, MSN, CBN, is from the Celebration Institute, Inc., Houston, Texas; Anita Houle is Insurance Authorization Specialist, Cleveland Clinic Florida Bariatric Institute, Weston, Florida.

Introduction
In recent years, there has been a dramatic increase in the number of weight loss surgery (WLS) procedures performed in the US. Subsequently, WLS-related medical insurance claims have soared. This increased cost to third-party payers has led to increased scrutiny of WLS procedures. Regardless, more and more individuals are considering it a viable option. This increasing interest is likely because of the realistic promise that successful WLS is expected to help some people control comorbid conditions, engage in regular activities, and improve self esteem. However, not all candidates have resources to cover payment for such surgery. Additionally, there are candidates who have resources but are challenged in accessing them. This challenge is often rooted in the process of insurance approval. Read the rest of this article »

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Dear Bariatric Times Editor:

On January 23, 2008, the headline on the front page of the New York Times read, “Diabetes Study Favors Surgery to Treat Obese.” With front page news stories in addition to television newscasts reporting the benefit of surgical procedures for the treatment of diabetes, it is logical to assume that the number candidates for these procedures will rapidly increase. Unfortunately, despite the impact of type II diabetes and the cost it imposes on our healthcare system, numerous barriers exist that make it difficult to obtain insurance pre-certification for coverage. Read the rest of this article »

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by James W. Saxton, JD; Maggie M. Finkelstein, JD;
and Susan Gallagher Camden, RN, MSN, PhD

All from Stevens & Lee, Lawyers and Consultants Read the rest of this article »

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by Jacqueline Jacques, ND

Dr. Jacques is Chief of Scientific Affairs, Bariatric Advantage, Catalina Lifesciences, Inc., Irvine, California.

Introduction
Selenium, an essential trace mineral, is an important component of many enzymes and proteins in the human body. Selenium-dependant compounds act as antioxidants, regulate thyroid function, and play significant roles in immune function, detoxification, and muscle metabolism.

Read the rest of this article »

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by Jerome Lyn-Sue, MD; Kimberley Steele, MD; Michael A. Schweitzer, MD; Thomas Magnuson, MD; Anne Lidor, MD; Anirban Gupta, MD; and Patrick Okolo, MD.

All from Johns Hopkins University School of Medicine, Baltimore, Maryland.

Introduction
Roux-en-Y gastric bypass is the most effective and most commonly performed bariatric surgical procedure in the United States.1 While improvements in surgical technique have significantly reduced postoperative complication rates, anastomotic leak continues to occur and remains an important cause of postoperative morbidity and mortality.2 Repair of an anastomotic leak may involve open or laparoscopic surgical re-exploration, which can contribute to the morbidity of this life-threatening complication.3 A transoral endoscopic approach, using a covered stent, has the potential to avoid further morbidity from a potentially difficult intra-abdominal attempt at repairing the hole. Covered stents have been used for esophageal anastomotic leaks following non-bariatric procedures with good success. Several reports have described the effective use of this therapy for such leaks, as well as for malignant esophageal fistulas.4,5 Read the rest of this article »

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You place a high level of importance on the multidisciplinary team and mention that this is an important part of the Betsy Lehman Report. Why is it so important to have a multidisciplinary care team within bariatric surgery?
Severe obesity is a multifaceted disease; thus the treatment needs to be multidimensional. Staff that make up a multidisciplinary care team use the expertise in their respective fields to provide input and evaluate and manage the patient throughout the surgery and follow-up period. More information about our multidisciplinary team can be found at www.BIDMC.Harvard.edu/WLS. Read the rest of this article »

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