Frequently Asked Questions

Greenwich Hospital performs surgery on adult patients from 18-75 years of age. Programs differ in their age limit. We believe that surgery can be safely performed on individuals over the age of 70, on a case-by-case basis. Your surgeon will discuss options with you.  

Adolescents under 18 years of age can enter our adolescent program, which is conducted jointly with pediatric medical specialists. For more information please contact 203-789-6237 and ask for the Adolescent Surgery Program.

There are many different levels of coverage for weight-loss surgery. Our staff will help determine what your specific policy covers. Here are some key steps you should take to obtain information from your insurance company. Document every visit you make to a healthcare professional for obesity-related issues or visits to supervised weight-loss programs. Document "other" weight-loss attempts made through diet centers and fitness club memberships. Keep good records, including receipts.

Payment may be denied because there may be a specific exclusion in your policy for weight loss surgery or "treatment of obesity." Such an exclusion can often be appealed when the surgical treatment is recommended by your bariatric surgeon or referring physician as the best therapy to relieve life-threatening obesity-related health conditions, which usually are covered. If you are told that your policy has an exclusion, you should always ask for a copy of your plan and read the benefit section yourself. Our staff can also assist you to determine what your options may be based on your plan.

Insurance payment may also be denied for lack of "medical necessity." A therapy is deemed to be medically necessary when it is needed to treat a serious or life-threatening condition. In the case of severe obesity, alternative treatments - such as dieting, exercise, behavior modification, and some medications - are considered to be available. Medical necessity denials usually hinge on the insurance company's request for some form of documentation, such as 1 to 5 years of physician-supervised dieting or a psychiatric evaluation, illustrating that you have tried unsuccessfully to lose weight by other methods.

Gather all the information (diet records, medical records, medical tests) your insurance company may require. This reduces the likelihood of a denial for failure to provide "necessary" information. Letters from your personal physician and consultants attesting to the "medical necessity" of treatment are particularly valuable. When several physicians report the same findings, it may confirm a medical necessity for surgery.

Even if your initial request for pre-authorization is not approved, you still have options available. Insurers provide an appeal process that allows you to address each specific reason they have given for denying your request. It is important that you reply quickly. It is also recommended that, at this point, you enlist the help of an experienced insurance attorney or insurance advocate to properly navigate the complexities of the appeal process. Some insurers place limits on the number of appeals you may make, so it is important to be well prepared and that you clearly understand the appeal rules of your specific plan.

In gastric bypass, the stomach is left in place with intact blood supply and remains unchanged. It does not receive food but contributes secretion to aid digestion.

Pain is minimal and generally controlled with acetaminophen. The laparoscopic incisions are typically very small. On average, four to six incisions are made for the medical devices to be used. Most patients recover in a shorter time and have a lower chance of wound complications (e.g. infection, hernia) than in an open surgical procedure. Some return to work in little more than a week and many quickly return to physical activity. Patients generally have very small scars and report a feeling of having “performed many sit ups.” Some discomfort from gas pain is common after surgery.

The staples used on the stomach and the intestines are very tiny in comparison to the staples you will have in your skin or staples you use in the office. Each staple is a tiny piece of stainless steel or titanium so small it is hard to see other than as a tiny bright spot. Because the metals used (titanium or stainless steel) are inert in the body, most people are not allergic to staples and they usually do not cause any problems in the long run. The staple materials are also non-magnetic, which means that they will not be affected by MRI. The staples will not set off airport metal detectors.

Typically you should be able to take most medication as before your surgery. Your team will review your medication plan with you.

Most people are able to take a decreased amount of medications as their health improves.

Weight loss after bariatric surgery varies from person to person. Typically, a patient will lose weight quickly after the first few months and then the pounds will come off more slowly. It usually takes about 12 to 18 months to achieve maximum weight loss. 

Patients MUST stop smoking at least two months before surgery. Smoking increases the risk of all complications after surgery. We can refer you to a smoking cessation program to help you achieve this. Please contact us and ask for this referral if you need it.

As we age, skin elasticity decreases, which can result in excess skin folds after weight loss. The amount of loose skin is variable among individuals.

Some patients will choose to have plastic surgery to remove loose or excess skin after they have lost their excess weight. Insurance generally does not pay for this type of surgery (often seen as elective surgery). However, some do pay for certain types of surgery to remove excess skin when complications arise from these excess skin folds. Ask your surgeon about your need for a skin removal procedure.

Exercise is an important part of maintaining your weight loss. Its effect on excess skin is variable.

Your doctor will determine whether medications for blood pressure, diabetes, etc., can be stopped when the conditions for which they are taken improve or resolve after weight loss surgery. For meds that need to be continued, the vast majority can be swallowed, absorbed and work the same as before weight-loss surgery.

Two classes of medications that should be used only in consultation with your surgeon are diuretics (fluid pills) and NSAIDs (Non-Steroidal Anti-Inflammatory Drugs), which are most over-the-counter pain medicines. NSAIDS (ibuprofen, naproxen, etc.) may create ulcers in the small pouch or the attached bowel.

Any type of surgery and obesity are risk factors for formation of blood clots — deep vein thrombosis (DVT) or pulmonary embolism (PE). These blood clots can form in the lower extremities (DVT) and travel to the lung (PE). The best way to avoid blood clots is prevention through:

• Early mobility after surgery
• Inflatable compression stockings while in the hospital
• Blood thinners in the hospital

It is important also to be active at home once you are discharged.