Gastric Bypass

CamiC

I just read October '04 postings on this topic, but my question wasn't answered. I just got an e-mail from an employee who says after a long deliberation she has decided to have the gastric bypass surgery. My first instinct is to send her the medical certification paperwork and a summary of her FMLA rights, and I plan to do that today. But my question is this, she has never had any health concerns that affected her work up to this point. Is an "elective" surgery like this one covered under FMLA? Can this be considered a serious health condition? Does the surgery itself create a serious health condition? And what about a breast implant procedure? Does that count too? Help!

szemcumo

Not sure on this but I think that the decision was both her and her phys. decision due to health reasons. If so I would think it would be covered. I don't think it is done for cosmetic reasons unlike breast implants would be. However breast reduction would be a different story. I'm sure someone will be able to help you better.

CamiC

Thanks!

mushroomHR

I have an employee who had this surgery performed. The doctor completed the FMLA certification form stating the employee had a condition that prevented him from performing his job duties. Therefore, I granted the FML.

I didn't have a problem with doing that as this surgery isn't something that a lot of people have. Out of an average employee count of 200, and over a 15-year span this is the only employee we've had to get this surgery.

nietra

We had an employee have this surgery last week and sent out the papers to have the physician decide if it was covered. The nurse called me back and said that they do this a lot and just needed an address to send them out.

HRinFL

I believe that this should be covered under FMLA because this is not always an elective surgery, but can also be a preventitive measure. While I am not sure of the ee's medical history or health, this is normally a procedure that is only performed on someone that is seriously overweight, to the point that there are health concerns for the patient. That should be enough to qualify the procedure for FMLA.

While obesity is not a qualifying condition under the ADA (yet), it can lead to serious health complications - such as heart attack, coronary heart disease, stroke, kidney disease, etc. It may be benefitial for your company to give the ee the time now instead of facing more serious health concerns in the future.

marc

I think the Gastric Bypass procedure is covered. Even our HMO is now covering these procedures through health insurance, which is a recent change.

deniseE

Gastric Bypass is not performed as an "elective" procedure, the way you would think of a nose job. Generally, the person must be a qualifying weight to be eligible for the surgery.

Let the doctor decide what is medically necessary and what is not. If you start to try to make these judgments for yourself you'll run into trouble. If the doctor certifies FMLA, you've done right by the ee and by your company.

System

Though obesity is not a disability under the ADA, morbid obesity is. I believe the surgery would be covered under FMLA since it is only performed in cases of morbid obesity; a surgery that corrects a disability.

Don D

I agree. It also should be pointed out that a doctor does not 'certify FMLA'. A doctor fills out a form giving you information upon which to base your decision to certify FMLA eligibility or not.

pork1

Don: You are so keen to make that perfect point and so right on.

My assistant had the procedure done and her husbands medical plan paid for the cost of medical treatment. She only missed two days of work for the surgery. FMLA was not required. She was up and loosing weight rapidly after two days. She has lost about 200 lbs. She spends alot of time in the restroom, voiding, which is acceptable, we all understand and support her anyway we can. We have flexed her schedule and fit her in to get the HR, payroll, benefits, W/C case management and whatever else done and proud of her for seeking the surgery.

For some FMLA may be required, but it was not in our real case.

PORK

Ethel

After tremendous weight loss from successful bypass, there is a hugh amount of excess skin. Is surgery for removal of this skin also covered by most policies and eligible for FMLA?

pork1

ETHEL: Again the physician would have to make that call. Our medical plan would not pay for this procedure. My assistant is now on our medical plan. She is no longer married to the person employed by another company.

If the physician could come up with a health hazard for excess skin, we might have to allow for the FMLA; however, our medical plan has already made a decision in her case that the excess skin, sufficient for two other people, is not a serious health condition. She has checked with the Burn Center in our state, and they are willing to pay for her skin removal and donation to burn victims.

Again this surgery would only keep her down for about a week and sick leave will cover her absents. This surgery is much more painful than the Gastric By-pass and the painful condition could effect her beyond her sick leave available, so she would probably just take vacation time. She is a super star and we will do whatever is necessary to help her!

PORK

Ethel

Pork:

The Burn Center -- How unique!! You probably just saved one of our people some real stress and anxiety!!! If our insurance company turns her down (which I think they will), this will give her an alternative to look into. Thank you so much!!!

pork1

CAMI: GASTRIC BY-PASS SURGERY could very well be the required physician's procedure to combat other serious health conditions. Our medical plan will not pay for an elected procedure, but will if the physician declares the procedure to be required or face additional medical issues.

The President/owner of our company declared the procedure should be banned from the medical field of interest. Without a complete psycological change in the individuals survival habits, life style associated with EATING, the procedure does not have a good track record.

My HR assistant has lost 180 + lbs and today is a very happy employee and has proven our President to be wrong. Some cases do work!

If the physician certifys the surgery as being required then FMLA may just be the right answer. However, my assistant worked up to the day before the surgery (Wed)and was back in the office and working to get payroll out the next Monday. She has never taken a day of her FMLA benefits. So pull back from the issue as a HR and provide the documentation and briefing, just in case. The EE might be a sickly case and may need to be off.

Bottom line always remember the granting of FMLA is contingent upon the certification of the physician and the formal request/application of the ee. I assume she qualifies for the FMLA.

PORK

CamiC

Thanks, I have more information from the EE now, and she does have some mitigating health problems that she didn't mention originally, and her husband's insurance plan has approved the procedure. I worry about her success because she loves to cook, and has delighted the staff in her office with goodies since she's been employed with us. I hope she has received some type of counseling from her doctor about the great lifelong changes that she will endure. I have no idea of her weight, but I would never have pegged her as someone who needed the surgery just by looking at her.

I gave her the docs for her and her doctor to complete, so the ball is in her court now. I really appreciate all of the information, especially that on the excess skin removal. I wonder if my EE knows about that!