PMRI Clearance??

Could someone going through Dr. Isaias Irgau office tell me exactly what PMRI is and what clearances are needed before surgery? Also, are there any differences between these requirements for the lapband vs. other types of bariatric surgeries? And finally, is it a good sign that I got authorization from BC/BS of DE to even have a consultation with the surgeon? Thanks!

PMRI is the Preventative Medicine and Rehabilitation Clinic. It is on Rt 52 at Rt 141 in Greenville (Pellport). I believe the clearances have the same requirements. If you're having surgery at Christiana, you take your lifeskills Classes and clearance thru PMRI. For BCBS patients you will have a out of pocket cost of $1200. This includes your Nurse Pract, Psychologist, Dietition, Classes, 5 years of support group meeting fees and your final meeting and physical with their medical doctor. If you have your surgery at St. Francis you will go thru their clearance system. The cost is less than Christiana. Go with whatever hospital youre most comfortable with. You will need to see a Cardiologist, Pulminologist, get an endoscopy, if you snore you will need to have a sleep study to determine if you have apnea (I recommend the Middletown facility). If any of these doctors find any problems, they will need to be addressed prior to surgery. I had to have my bloodpressure medicated and am waiting on a biopsy on something in my uterus, BCBS is one of the fastest to give approval as long as it is medically necessary (I think you need to have like 3 of the co-morbidities that they list). If you don't have those problems, then I think you need to be on like 6 mos-1 yr of a medically supervised diet. Document everything and make sure that each doctor you see faxes their results & reports to Misty ASAP. I am stuck waiting for a couple of reports and labwork that didn't get in before I had my final physical last night. Good Luck and welcome aboard! Dee

Thanks Dee...you got this surgery thing covered!!! I hate to be a pain in the butt but could you possible answer some question from my first post. I got an approval from BC/BS of DE POS for 1 visit with Dr. Isaias Irgau (which I though was a victory in itself). My visti is on 6/2 and now I'm not sure I will qualify for the surgery. I am 44 years old, weigh in at 215 lbs. and 5'4 or 5'5 (it's always different), my BMI is 36 or 37 and have recently been diagnost with "mild" sleep apnea (my numbers don't qualify for the cpac), asthma, shortness of breath, GERD, high cholestrol and triglyserides (even with meds it is still high), edema, depression (who wouldn't be??), cervical disk degeneration, migrains, and a bunch of other "little things" that seemed to have crept up on me. I have track my weight history back over 30 years (which really made me sad to relive all the failures) and I have documented numerous medicall supervised weight loss attempts using phentermine and xenical (is xenical a diet drug??). So I guess my question are...is mild sleep apnea considered a co-morbity? Even though I have documentation of a lot of diet attempts none of them are for this year. Will they still count if they was 12 straight month but in 1998 and 2003 (with other documented attempts in between)? They said my GERD is "moderate". My doctor says that is significant, is it? And my joint aches and pains aren't documented as arthitis but I was give perscription arthitis meds for it, will that count? OK, I've gone on long enough. I appreciate your help.

I never got pre-approval for my consult. I just made the appointment on my own. As soon as Misty heard that I had BCBS DE PPO she said that I should be fine. Hell, I hadn't even seen my PCP in 7 years other than whenever I hurt myself and he was on duty at Limestone Medical. I'd been treating my gerd with OTC Zantac for years (yes I'm an idiot!). BCBS paid the bill. All I did is pay my $20 co-pay when I got to the office. They've paid every bill that has been submitted so far, no problem. I'm very careful about using doctors that are in the system. Misty gave me a list of BC recommended physicians for all of the necessary tests. It sounds like you have more documentation than I do. Everything you have listed are co-morbidities. The psychologist will especially be interested in the phentermine (tell the cardiologist also), and tell her/him exactly what diets you've been on, how much you lost, and how much you gained back. I missed telling her about the OTC diet pills, laxatives (I am ashamed of myself for that, I do know better), and the attempted bulemia (I wasn't successfull, I really hate to vomit) so she tried to tell me that I hadn't tried hard enough in the past 4 years. They made me meet with the dietition one-on-one, but I threw a fit about the extra cost and they included it in the fee that I'd already paid. I met with her and she gave her approval right away. If you have to meet with a dietition, it's best to go after you've taken some of the life skills classes so you will be better informed about your diet. Make sure you make a list of all medications you're taking, and if they discover any new problems, make sure you contact the NP at PMRI and have her make a note of the new med and the doc that prescribed it in your file. I found out that I had high bloodpressure during my testing for my clearances and had to go on meds for it. I really don't forsee you having too many problems getting approval from BCBS. But be prepared anyway. Keep your own notes and records too. I've heard that BCBS is the easiest to get approval from as long as you have 2-3 of the co-morbidities. You definately have that covered. Good luc****ep me informed. We can compare notes. Hope this helps. Dee

Dee, YOU'RE THE BEST!! You helped take the edge off the waiting for me!! Thank you soooooo much! Lisa