Making the Weight Loss Surgery Choice

Find a Surgeon
Questions to Ask Your Doctor
Questions to Ask Your Surgeon
The Importance of Support
Insurance For Bariatric Surgery Financial Considerations
                      Calling your Insurer
                      Sample Letters
Preparing for Weight Loss Surgery 
                      What to take to the hospital

Mapping out your plan of attack
So, you're ready for weight loss surgery. At this point, there are several things that need to be done, but different ways they can happen. One way to make your weight loss surgery choice is to pick a surgeon and then let their office handle everything for you. For some centers, this may work fine. Here, we offer a breakdown of the various steps involved and invite you to consider taking a more active role in managing the process. Provided that you proceed with care, not only might the weight loss surgery process go much faster but you'll be better empowered to monitor and handle any setbacks.

For the weight loss surgery process, you need:

• a surgeon covered under your plan
• a referral from your PCP to that surgeon
• a host of letters from clinical specialists documenting medical necessity of the weight loss surgery.

Here is a possible sequence of events leading to weight loss surgery:

1. Research candidate surgeons you feel comfortable with.
2. Contact your insurer with specific questions and determine if you have insurance for bariatric surgery.
3. Narrow your surgeon selection based on network participation and surgery type covered.
4. Obtain letters from clinical specialists such as a dietician and psychologist regarding your need for weight loss surgery.
5. Obtain a letter of medical necessity and referral to a surgeon from your primary care physician (PCP). Note: in some cases you may need a referral from your PCP in order to do the previous step.
6. Visit your surgeon and mail out your packet to the insurance company.

Click here to watch our ?Making the Journey? movie, an interactive walk through the process, to better understand the weight loss surgery journey.

 Find a Surgeon
Obesity is a lifelong disease and is best treated by a Center that can provide you with many different weight loss surgery options plus long-term follow-up treatment. Visit Centers you are considering to see if the facility is clean and the staff friendly and knowledgeable. Check pricing and insurance for bariatric surgery. Use the Internet to research the Center's outcomes.

Also know what you are shopping for: surgery, or no surgery? You want to choose a Center that offers this option if you know or suspect you will consider surgery at some point in your weight loss program. There are several types of surgery aimed at helping patients eat less food by creating a smaller stomach, resulting in rapid weight loss.

Weight Loss Surgery Techniques
Roux-en-Y gastric bypass surgery involves separating the stomach into one small part and a larger part. The small part of the stomach functions as a food pouch and conducts food directly into the small intestine. The larger part of the stomach is then bypassed and not used to process food, resulting in rapid weight loss. This procedure can be done with a large incision or laparoscopically to reduce pain and recovery time. A laparoscope is a viewing tube the surgeon inserts through a band-aid size hole to see what they are doing. Other instruments are inserted through the same hole or other holes. The surgeon uses these instruments and the viewing tube to perform the surgery and see what he is doing.

Another type of surgery is called laparoscopic adjustable gastric band surgery. An adjustable band is placed around the patient's stomach to form the small food pouch, resulting in rapid weight loss.

Other tips on how to choose a bariatric weight loss center include:

• Avoid Centers or programs that do not offer follow-up treatment after weight loss surgery.
• Ensure the Center is conveniently located to your home.
• Ensure the Center offers exercise physiologist to develop an exercise program after the weight loss surgery.
• Do not choose a Center if they try to give you a "hard sell" for weight loss surgery. Walk away.
• If you do choose weight loss surgery, make sure your Center or hospital can treat any complications that may develop.
• Be prepared for the emotional ups and downs of rapid weight loss. You may feel deprived because you cannot eat all the food you like in the amounts you would like. Going out to eat, to the local food festival, or to parties may not feel like fun while you are adjusting to changes in your eating habits.
• Seek professional counseling if you find yourself becoming unusually depressed or angry from your change in eating habits. Rapid weight loss is a drastic life change.
• Motivation and exercise are key elements of successful weight loss, whether through surgery or a concentrated program. Be sure you are able to make the necessary commitment after your weight loss surgery.

If you are needing additional assistance in finding a surgeon in your area please contact us Monday-Friday 9am-5pm PST 1-866-297-4964

 Questions to ask your Doctor
You should work with your doctor to document your weight loss attempts, including all previous weight loss programs or efforts in which you have participated. You should also carefully record any obesity-related health conditions you suffer from and if they are getting worse. Are you continuing to sleep poorly? Are you having more and more trouble walking? How high is your blood pressure compared to two or three years ago?

These records will help you decide if weight loss surgery is an option for you. They will also help provide the health history necessary to obtain insurance for bariatric surgery.

Other weight loss questions to ask your doctor regarding weight loss information:

• How would I benefit from weight loss?
• What are my best weight loss options now?
• Am I a candidate for weight loss surgery?
• What are the next steps I should take?
• Can you refer me to a bariatric surgeon?
• What should I look for in a bariatric surgeon?

 Questions to ask your Surgeon
Being a well-informed patient is good for you and good for your doctor. Here are some of the questions you should ask before deciding on a bariatric surgeon: What types of weight loss surgery procedures have you performed?

Click here for list of questions courtesy of Amy Williams

 The Importance of Support
Many successful gastric bypass weight loss surgery patients say that their support network helped them immensely in maintaining their new healthy lifestyle changes. From family and friends to bariatric program support groups, there is a wealth of options available for people interested in gastric bypass surgery and for dealing with the rapid weight loss that follows.

The first step in getting support is talking to your family and friends about weight loss surgery and your interest in it. You might find that they are completely supportive. While this is always ideal, you might find that some family members and friends are against your decision. Often, this is because your loved ones are concerned about you or have preconceived notions about weight loss surgery. Explaining the advantages, benefits, and risks of weight loss surgery may open their minds to its importance.

If you find that they are unsupportive, it doesn?t mean you are alone. Many people have had weight loss surgery and have been very successful with the care they received from the healthcare professionals on their bariatric program team. Bariatric programs usually include a support group for weight loss surgery patients both pre- and post-surgery.

Weight loss surgery support groups are an excellent resource of weight loss information and support. You?ll find people who share your goals of health and wellness. A support group is a forum for celebrating successes, such as the improvement or resolution of co-morbidities. The support group is devoted to people who have common experiences, who can share their feelings in a safe environment, and develop relationships that can contribute to improved physical and emotional health after their weight loss surgeries.

If you are thinking about weight loss surgery, and you want to learn more about the patient?s perspective or help reluctant family and friends to understand, attending a support group meeting can be invaluable.

Getting Family and Friends to Support My Decision to Have Weight Loss Surgery

It?s important to realize that for many people, not just patients, surgery can be frightening. For weight loss surgery patients, family and friends may not be supportive in the beginning because, as with all surgical procedures, they are concerned about possible risks and complications.

If you find that your family and friends are not supportive of your desire to undergo weight loss surgery, providing information and education may calm many of their fears. In addition to support groups, many bariatric surgery programs provide information sessions and encourage the attendance of prospective patients, their family, and their friends. Seeing and hearing the successes of others can help people understand the importance of weight loss surgery.

What If My Family and Friends Don?t Support Me

Unfortunately, some gastric bypass patients find that their family and friends do not support their decision to have weight loss surgery. It can be very disappointing, but it doesn?t have to alter the patient?s decision to have weight loss surgery.

Bariatric surgery programs often include two components that can help a patient: a psychologist and support groups. A psychologist can provide tips and techniques for dealing with unsupportive people and listens to your frustrations without judgment.

Support groups are a wonderful place to meet people and get perspective on weight loss surgery and the rapid weight loss and side effects that follow. You?ll hear about successes, frustrations, plateaus, and special moments, and have a chance to share your own experiences.

 Insurance & Financial Considerations
You can also find more information about insurance for bariatric surgery and denials in the Insurance Help Forum.

Tens of thousands of people using the Internet come to ObesityHelp.com every day to research their insurance company or provider's record of approval for bariatric surgery for different types of patients. This information helps people adjust their expectations and can supply valuable comparison information to those faced with coverage denials. We encourage the posters to update their postings where this may be applicable.
 
Note:  These comments are posted by the public. We do not endorse or recommend any of the companies or agencies.

Paying for Your Weight Loss Surgery: Insurance for Bariatric Surgery

After you have spent a significant amount of time exploring the option of weight loss surgery, you will need to determine how to pay for the surgical procedure.  A growing number of states have passed legislation that requires insurance companies to provide benefits for weight loss surgery for patients that meet the National Institutes of Health surgical criteria.  And while insurance for bariatric surgery is widespread, it often requires a lengthy and complicated approval process. The best chance for obtaining approval for insurance coverage comes from working together with your bariatric surgeon and other allied professionals in the office and at the hospital.

Important steps you should take to obtain insurance bariatric surgery:

• Read and understand the "certificate of coverage" that your insurance company is required by law to give you. If you do not have one, consult your company's benefits administrator or ask your insurance company directly.
• You may be required to start with your primary care physician. In some cases, he or she is the only one you can ask for a referral to a qualified bariatric surgeon. Even if you are not required to get a referral, it is a good idea to have the support of your primary care physician.
• Before visiting the bariatric surgeon, organize your medical records, including your history of dieting efforts. They will be valuable documents to have at every stage of the approval process.
• 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.
• If your bariatric surgeon recommends weight loss surgery, he or she will prepare a letter to obtain pre-authorization from your insurance company. The goal of this letter is to establish the "medical necessity" of weight loss surgery and gain approval for the procedure. The following information is generally included in the pre-authorization letter:
   
  • Your height, weight and Body Mass Index and any documentation you might have as to how long you have been overweight.
  • Simply describing your condition as "morbid obesity" is not enough. A full description of all your obesity-related health conditions, including records of treatment, a history of medications taken and documentation of the effects these conditions have had on your everyday life is necessary.
  • A detailed description of the limitations your excess weight places on your daily activities, such as walking, tying shoes, or maintaining personal hygiene.
  • A detailed history of the results of your dieting efforts, including medically and non-medically supervised programs, medical records and records kept of payments to and meetings attended with commercial weight loss programs.
  • A history of exercise programs, including receipts for memberships in health clubs.
  • Ask your doctor to include information from medical journals regarding the effectiveness of weight loss surgery, particularly information showing the control or elimination of obesity-related health conditions.
  • Thirty days is the standard time for an insurance provider to respond to your request. You should initiate a follow-up if you have not heard from your insurance company about insurance for bariatric surgery in that time.

 Calling your insurer:

Questions to Ask
Choose your strategy

 Sample Letters:

Dietician letter
Psych evaluation
Sleep test
Letter of medical necessity
Working with your PCP
Sample letter to your PCP
Completing your packet

 Preparing for Weight Loss Surgery

Bariatric surgery is like other major surgeries. You can best prepare by knowing the benefits and risks of surgery and by closely following your doctor's instructions. To mentally prepare yourself:

• Understand the surgical process involved with your weight loss surgery and what to expect afterward, including any side effects of rapid weight loss.

• Keep in mind that you?ll never be able to eat the way you did before, and that you?ll have to watch the way you eat for the rest of your life. Your bariatric surgeon will discuss the benefits and risks of the different surgical procedures, and together you will choose the most appropriate surgery for you. Once you and your surgeon have agreed upon a weight loss surgery procedure, your next step will be to set a date. Learn more about the day of surgery here.
• Talk to people who have had weight loss surgery. You can hear the stories of other patients in the Voices of Experience section.
• Write a letter to yourself and your surgeon explaining your reasons for having weight loss surgery and outlining your plans to maintain your weight loss after surgery.
• Start a journal. Record how you feel now, the challenges you face, and the things you hope to be able to do after weight loss surgery.
• Get a letter of support from your family. It helps to know you have people behind you, waiting to help, after your weight loss surgery.

To prepare yourself physically, follow the guidelines that your doctor will give you. The guidelines about weight loss information will be based upon your procedure, your personal profile, and other factors. You want to ensure your best outcome, and the guidelines will help you accomplish that.  Before consulting a professional, visit our Resource Library to browse helpful, informative tip sheets.

 Hospital List for Your Weight Loss Surgery Courtesy of Moni

• Lip balm / chap stick?for the dry lips when you can?t have ice chips
• Baby wipes or antibacterial wipes to freshen up
• Trial size baby lotion or favorite lotion
• Small shampoo and conditioner
• Brush, hair ties
• Toothbrush and paste ?the hospital provides some but it tastes horrible
• Deodorant
• Insurance card and living will or health care proxy, medication list
• Your own pillow w/colored case (this will be handy for the ride home too)
• Loose clothes to wear home and a good pair of non slip sole slip on shoes?you will hate to bend over to put on shoes
• Camera in case you want to document the journey ?this is an optional item
• Phone numbers in case you want to call family/friends
• Sanitary napkins (a lot of women will start their cycle right after surgery)
• Eye covering (if light bothers you), earplugs (if noise bothers you)
• Pictures of family or loved ones?This is an optional item
• Small fan ?this is an optional item
• Get some type of long wooden spoon or something you can wrap toilet tissue around. If that doesn't work, get a family member to help wipe.
• A robe and house shoes to walk in the hall after surgery
• Some reading material like magazines?you won?t get through a book with all the drugs they have you on.
• CPAP machine (if Dr. requires it)
• Albuterol rescue inhaler

Pack your bag to go to the hospital and then remove HALF of that. You won't use it all!

Post-op List for Your Weight Loss Surgery

• Lots of small dishes to eat from
• Replace all the batteries in things you use regularly (TV control, VCR controls, cordless phone, etc)
• Buy yourself a small bag of sugar-free peppermints. These are great if your queasy post-op or peppermint tea.  Hot tea is a great help in the morning to relax your new pouch.
• Small plastic dishes for freezing and or refrigerating left -overs
• Small spoons and forks
• Extra measuring cups and spoons
• Vitamin e oil for dry stomach skin
• Foods that can be eaten post op. Bottled water ,baby apple juice (Dole,),instant breakfast, no sugar added popsicles, jell-o pudding, some type of protein powder, gatorade ,chicken broth, instant mashed potatoes.
• A good strainer to strain the chunks out of soup
• For those of you that don't have a shower seat, see if someone you know has one you can borrow (bleach the thing before using of course though) or purchase one if possible. Make sure if you are borrowing one that it has rubber grips on the feet of it though that are in good shape. You certainly don't want to slip and fall in the shower
• One of those grabbers that you can pick things up off the floor
• Whatever vitamins and supplements you plan on taking
• Protein shakes and shaker cups
• Bags of ice?for getting in fluids and making shakes cold
• Mederma or scar gone to heal incisions
• Food processor or magic bullet to blend the food 

When you arrive, you will undergo a few preoperative steps. You will change out of your clothes. You will see your nurses, and often, you will see your surgeon as well as your anesthesiologist. An IV line will be started to keep you hydrated and to administer medications such as antibiotics. The preoperative experience is often a short one, after which you will be taken to the operating room.

If you are not already under anesthesia before you get to the operating room, you will be once there. Then, you will be intubated and your surgeon will perform the operation. Gastric bypass procedures, whether they are minimally invasive or open, are fairly short ? about 75 to 90 minutes.

After surgery, your healthcare team will make sure that your vital signs are correct and arrange for you to be taken to a recovery room.