Okay, where do I start???
Hello everyone!
I am ready to begin the entire process. I have shbp insurance and I am waiting to change my insurance plan to Cigna HRA. I want to get all of my paperwork done before the beginning of the year. I want to have VSG completed and I have a surgeon in mind. So, I don't know where to begin. Should I attend a seminar for my surgeon (wondering if they will talk to me without correct insurance), or simply complete support meetings and pcp visits? Thanks everyone!
Nilesmama08
I think you should go see your doctor and you can tell them what is going on and they can tell you what will be expected of the new insurance. At least that way you can get the ball rolling even if you don't have that insurance yet.
RNY 5-12-04 Done at St Vincents Hospital in Carmel Indiana by Dr Margaret Inman.
Would I do it again? IN A HEARTBEAT!! Best gift I ever gave myself.
Would I do it again? IN A HEARTBEAT!! Best gift I ever gave myself.
I have Cigna shbp HRA. I went through the pre-op process in 2008-2009. You can absolutely start your pre-op testing NOW, so by Jan 1, 2011 when your new insurance kicks in, you go right ahead and submit to insurance.
These are things you should be doing now:
1. Attend 6 physician supervised diet visits. Must be done 1x per month with no gaps. They must record height, weight, bmi, diet and exercise therapy. You can do this with your pcp or a bariatric surgeon. You may use Weigh****chers, Jenny Craig, etc for your diet, but still will need to see the physician for them to monitor it, so I figure just save the $$$ and see the doctor and let them give you a diet.
Your pcp will need to give you the ok to have wls. At your 1st diet visit try to get a feel for whether your pcp will be supportive. If not SWITCH :-)
Also, make sure they document your 1st visit as a diet visit and not an office visit.
2. Attend 6 bariatric support meetings 1x per month. DO NOT skip a month. They WILL deny you! Make sure it is a bariatric meeting. It does not have to be run by a surgeon. I facilitate a group in Stockbridge, and I have forms for you to sign, so you will have proof of attendance. We meet 2nd Saturday of every month at Henry Medical. I believe this is the closest group to you. There is another group at Southern Regional, but they charge $350 if you are not a lap-band patient there.
3. Meet with a nutritionist (I'd wait to select a surgeon 1st because some of them will want you to use their nutritionist)
4. Meet with a therapist for psych clearance. (I'd wait to select a surgeon 1st because some of them will want you to use their nutritionist and psych). You'll want to do the nutritionist and psych close to the end of your process because they may quiz you on wls. You want to be well informed before you do these visits. They will want to make sure you are knowledgeable about the wls you are having and how it will change your life.
5. Try to narrow down the type of wls you will have. When I got into this I was having lap-band hands down. here was just NO way anybody was cutting me up... Thank God somewhere along the way I had a reality check and opted for the DS. Cigna covers DS, rny, lap-band, Realize band, vertical sleeve (vsg) and vertical banded gastrectomy.
6. Meet with at least 3-4 surgeons that do all 4 wls procedures, to get an impartial opinion on which is best for you.
7. Choose a surgeon and surgery. You probably won't actually sit down with your wls surgeon until you are well into the process and maybe not even until you've been approved. If you get a chance take a few minutes to pick his brain when you attend his seminar.
There will be other pre-op tests required, and each surgeon has different protocol. Some require upper gi, ekg, chest x-ray, endoscopy, sleep studies, Idexa scan, Metabolic testing... These are things you'll just have to wait and do once you've chosen a surgeon.
- RESEARCH, RESEARCH, RESEARCH. There is tons of info on wls out there. Great books are available for free at the public library. There is just no reason for anybody to have wls and not be well informed about it.
- Consider how much you weigh, and how much you want to lose?
- Do you have any co-morbidities like diabetes or hypertension, or does it run in your family? If so DS or rny will be best.
- What are your eating habits? Do you binge? Eat high volumes, fill up on sweets? Snack? You probably never really thought about what, when , or how much you're eating. Start a food diary, or use an online tracking tool like thedailyplate.com to see what areas you need to improve on. Different wls are more effective for different eating habits. For example rny can be an effective tool for a sweets binger because the "dumping syndrome" may be a deterrent from overdoing it.
VSG may be good if you eat the right stuff, just too much of it.
- Are you good at sticking to a diet? Will you do it the rest of your life? BE HONEST! The less malabsorbtive a procedure, the more work YOU will have to do to make the wls work, and keep the weight off. DS is the most malabsorbtive wls, and allows more freedom in the amount and variety you will be able to eat and keep your weight down. If you know you are not going to be compliant the rest of your life, stay away from restrictive only wls like lap-band and vsg. You WILL gain the weight back when you start your old eating habits again.
- What are you willing to give up? Would you be ok with never having sweets again if you have a rny and are susceptible to dumping? Some rny dump on a tiny bit of sweets, others can sneak a few nibbles, some don't dump at all. But, if you potentially dumped on a few Skittles would you be ok with that?
- How much maintenance are you willing to do? Will you go in for your lap-band fills? Will you take your vitamins for rny or DS? Are you going to make sure you get in your protein?
This is the time for some deep self reflection and honesty. You may have to have a more aggressive wls than you want to have to get the results you NEED.
AS YOU ARE GOING THROUGH THIS KEEP COPIES OF EVERYTHING! NOTHING CAN BE MORE FRUSTRATING THAN TO GO THROUGH THIS WHOLE PROCESS AND HAVE YOUR PAPERWORK BE LOST. YOUR SURGEON MAY HAVE 1000'S OF PATIENTS. IT IS POSSIBLE FOR SOMETHING TO GET LOST. INVEST IN A 3 RING BINDER AND DIVIDERS AND START SAVING COPIES OF EVERYTHING!!!
I STILL HAVE MY BINDER. I TOOK IT EVERYWHERE WITH ME, AND IT CAME IN HANDY A FEW TIMES. I DIVIDED IT INTO TABS :
1. FINANCIAL-INSURANCE INFO,
2. TEST RESULTS,
3. RESEARCH WLS SEMINAR INFO, ETC
4. DIET VISITS, ETC...
5. EMAILS WITH SURGEON, ETC...
Best wishes with the process!!! I am here if you need me, and I live close by. I hope to see you at a support meeting soon :-)
These are things you should be doing now:
1. Attend 6 physician supervised diet visits. Must be done 1x per month with no gaps. They must record height, weight, bmi, diet and exercise therapy. You can do this with your pcp or a bariatric surgeon. You may use Weigh****chers, Jenny Craig, etc for your diet, but still will need to see the physician for them to monitor it, so I figure just save the $$$ and see the doctor and let them give you a diet.
Your pcp will need to give you the ok to have wls. At your 1st diet visit try to get a feel for whether your pcp will be supportive. If not SWITCH :-)
Also, make sure they document your 1st visit as a diet visit and not an office visit.
2. Attend 6 bariatric support meetings 1x per month. DO NOT skip a month. They WILL deny you! Make sure it is a bariatric meeting. It does not have to be run by a surgeon. I facilitate a group in Stockbridge, and I have forms for you to sign, so you will have proof of attendance. We meet 2nd Saturday of every month at Henry Medical. I believe this is the closest group to you. There is another group at Southern Regional, but they charge $350 if you are not a lap-band patient there.
3. Meet with a nutritionist (I'd wait to select a surgeon 1st because some of them will want you to use their nutritionist)
4. Meet with a therapist for psych clearance. (I'd wait to select a surgeon 1st because some of them will want you to use their nutritionist and psych). You'll want to do the nutritionist and psych close to the end of your process because they may quiz you on wls. You want to be well informed before you do these visits. They will want to make sure you are knowledgeable about the wls you are having and how it will change your life.
5. Try to narrow down the type of wls you will have. When I got into this I was having lap-band hands down. here was just NO way anybody was cutting me up... Thank God somewhere along the way I had a reality check and opted for the DS. Cigna covers DS, rny, lap-band, Realize band, vertical sleeve (vsg) and vertical banded gastrectomy.
6. Meet with at least 3-4 surgeons that do all 4 wls procedures, to get an impartial opinion on which is best for you.
7. Choose a surgeon and surgery. You probably won't actually sit down with your wls surgeon until you are well into the process and maybe not even until you've been approved. If you get a chance take a few minutes to pick his brain when you attend his seminar.
There will be other pre-op tests required, and each surgeon has different protocol. Some require upper gi, ekg, chest x-ray, endoscopy, sleep studies, Idexa scan, Metabolic testing... These are things you'll just have to wait and do once you've chosen a surgeon.
- RESEARCH, RESEARCH, RESEARCH. There is tons of info on wls out there. Great books are available for free at the public library. There is just no reason for anybody to have wls and not be well informed about it.
- Consider how much you weigh, and how much you want to lose?
- Do you have any co-morbidities like diabetes or hypertension, or does it run in your family? If so DS or rny will be best.
- What are your eating habits? Do you binge? Eat high volumes, fill up on sweets? Snack? You probably never really thought about what, when , or how much you're eating. Start a food diary, or use an online tracking tool like thedailyplate.com to see what areas you need to improve on. Different wls are more effective for different eating habits. For example rny can be an effective tool for a sweets binger because the "dumping syndrome" may be a deterrent from overdoing it.
VSG may be good if you eat the right stuff, just too much of it.
- Are you good at sticking to a diet? Will you do it the rest of your life? BE HONEST! The less malabsorbtive a procedure, the more work YOU will have to do to make the wls work, and keep the weight off. DS is the most malabsorbtive wls, and allows more freedom in the amount and variety you will be able to eat and keep your weight down. If you know you are not going to be compliant the rest of your life, stay away from restrictive only wls like lap-band and vsg. You WILL gain the weight back when you start your old eating habits again.
- What are you willing to give up? Would you be ok with never having sweets again if you have a rny and are susceptible to dumping? Some rny dump on a tiny bit of sweets, others can sneak a few nibbles, some don't dump at all. But, if you potentially dumped on a few Skittles would you be ok with that?
- How much maintenance are you willing to do? Will you go in for your lap-band fills? Will you take your vitamins for rny or DS? Are you going to make sure you get in your protein?
This is the time for some deep self reflection and honesty. You may have to have a more aggressive wls than you want to have to get the results you NEED.
AS YOU ARE GOING THROUGH THIS KEEP COPIES OF EVERYTHING! NOTHING CAN BE MORE FRUSTRATING THAN TO GO THROUGH THIS WHOLE PROCESS AND HAVE YOUR PAPERWORK BE LOST. YOUR SURGEON MAY HAVE 1000'S OF PATIENTS. IT IS POSSIBLE FOR SOMETHING TO GET LOST. INVEST IN A 3 RING BINDER AND DIVIDERS AND START SAVING COPIES OF EVERYTHING!!!
I STILL HAVE MY BINDER. I TOOK IT EVERYWHERE WITH ME, AND IT CAME IN HANDY A FEW TIMES. I DIVIDED IT INTO TABS :
1. FINANCIAL-INSURANCE INFO,
2. TEST RESULTS,
3. RESEARCH WLS SEMINAR INFO, ETC
4. DIET VISITS, ETC...
5. EMAILS WITH SURGEON, ETC...
Best wishes with the process!!! I am here if you need me, and I live close by. I hope to see you at a support meeting soon :-)
**** I AM AN OH SUPPORT GROUP LEADER ****
WHY I CHOSE DS: No dumping. Highest percentage of weight loss, Best long term results, Won't regain weight! Eat normal sized meals, 96% diabeties, 90% high blood pressure, 80% sleep apnea cured. I 
MY DS!
My doctor told me to stop having intimate dinners for four unless there were three other people. ~Orson Wells
Thanks for this comprehensive list, I appreciate it. I'm in the early stages--I've pretty much made up my mind to have VSG. However, I've not seen a doctor (other than my midwife) for a physical in about five years. So I'm starting with a brand new PCP, and am meeting him on 7/13.
Do the bariatric centers/surgeons offer complimentary consulations, or do most of you meet them at their seminars? So far I've not been able to attend one at any of the locations that they've been offered, although I have watched the online seminar that Emory has on their website. I'm not clear on whether when I see my PCP, I should be asking for a specific referral, or just discussing my plans to have the surgery and hoping he'll be on board. Of course, I want to meet a few of the surgeons before choosing one.
Mostly, I just want to get the ball rolling. I'm hoping that Cigna will accept my sporadic enrollment in Weigh****chers over the past 18 months as my medically approved 6 month diet, but I"m not too hopeful about that after reading experiences that others have had.
Thanks again for this info!
Do the bariatric centers/surgeons offer complimentary consulations, or do most of you meet them at their seminars? So far I've not been able to attend one at any of the locations that they've been offered, although I have watched the online seminar that Emory has on their website. I'm not clear on whether when I see my PCP, I should be asking for a specific referral, or just discussing my plans to have the surgery and hoping he'll be on board. Of course, I want to meet a few of the surgeons before choosing one.
Mostly, I just want to get the ball rolling. I'm hoping that Cigna will accept my sporadic enrollment in Weigh****chers over the past 18 months as my medically approved 6 month diet, but I"m not too hopeful about that after reading experiences that others have had.
Thanks again for this info!
Hey Tay, glad I could help you...
1st, You can NOT use the Weigh****chers Visits for your 6 month diet unless you visited the doctor 1x per month for 6 consecutive months while you were on Weigh****chers for the purpose of them monitoring your diet. The rules are very clear and there is no deviation.
You have to go see a doctor 1x per month for 6 consecutive months. Do NOT skip a month! They WILL DENY YOU!!!
When you visit the doctor, s/he has to record your weight, diet, and exercise therapy. Even of you are going for a cold, virus, whatever, have them mark it as a diet visit.
You also need to have your health problems (co-morbidities) documented. If you haven't seen a doctor in 5 years, you need to start documenting stuff now by seeing a doctor regularly. If your bmi is in the 35-45 range, you will need 2 documented co-morbidities for insurance to approve you.
Second,
No, the wls surgeons do not offer free consults. It will be billed to you as a regular office visit, Even if your current plan does not cover wls, it should cover the consult appointment and the 6 month supervised diet visits, and most if not all of the testing. It likely WILL NOT cover the program fee if your surgeon has one. It is very common for you not to even sit face to face with the surgeon until after you have your insurance approval. Others will see you once before you get approved for an initial consult, but won't see you again until your pre-op appointment. This was strange for me, but I think it's an industry standard.
Many surgeons are present at their wls seminar, and are available for questions after the seminar. Make sure you ask if s/he will be there when you register for the seminar, especially if it is a large practice with a group of surgeons. They may rotate who gives the presentation, so you'll want to pick a date when your desired surgeon will be present.
This is your time to pick their brain. Don't be shy ASK QUESTIONS at the seminar. It's good to jot down a list before you go, so you'll be prepared. You will be exposed to a lot of info in about 30 min- 1 hr, so it's easy to forget something you meant to ask.
You may be able to contact a surgeon by e-mail to ask personal questions, so ask him for his e-mail address if you get the chance for a one on one conversation at the seminar.
If you have shbp insurance, you won't need a referral to see a wls surgeon. The HRA and High Deductible plans do not require a referral to see a specialist, and you are not required to select a pcp.
1st, You can NOT use the Weigh****chers Visits for your 6 month diet unless you visited the doctor 1x per month for 6 consecutive months while you were on Weigh****chers for the purpose of them monitoring your diet. The rules are very clear and there is no deviation.
You have to go see a doctor 1x per month for 6 consecutive months. Do NOT skip a month! They WILL DENY YOU!!!
When you visit the doctor, s/he has to record your weight, diet, and exercise therapy. Even of you are going for a cold, virus, whatever, have them mark it as a diet visit.
You also need to have your health problems (co-morbidities) documented. If you haven't seen a doctor in 5 years, you need to start documenting stuff now by seeing a doctor regularly. If your bmi is in the 35-45 range, you will need 2 documented co-morbidities for insurance to approve you.
Second,
No, the wls surgeons do not offer free consults. It will be billed to you as a regular office visit, Even if your current plan does not cover wls, it should cover the consult appointment and the 6 month supervised diet visits, and most if not all of the testing. It likely WILL NOT cover the program fee if your surgeon has one. It is very common for you not to even sit face to face with the surgeon until after you have your insurance approval. Others will see you once before you get approved for an initial consult, but won't see you again until your pre-op appointment. This was strange for me, but I think it's an industry standard.
Many surgeons are present at their wls seminar, and are available for questions after the seminar. Make sure you ask if s/he will be there when you register for the seminar, especially if it is a large practice with a group of surgeons. They may rotate who gives the presentation, so you'll want to pick a date when your desired surgeon will be present.
This is your time to pick their brain. Don't be shy ASK QUESTIONS at the seminar. It's good to jot down a list before you go, so you'll be prepared. You will be exposed to a lot of info in about 30 min- 1 hr, so it's easy to forget something you meant to ask.
You may be able to contact a surgeon by e-mail to ask personal questions, so ask him for his e-mail address if you get the chance for a one on one conversation at the seminar.
If you have shbp insurance, you won't need a referral to see a wls surgeon. The HRA and High Deductible plans do not require a referral to see a specialist, and you are not required to select a pcp.
**** I AM AN OH SUPPORT GROUP LEADER ****
WHY I CHOSE DS: No dumping. Highest percentage of weight loss, Best long term results, Won't regain weight! Eat normal sized meals, 96% diabeties, 90% high blood pressure, 80% sleep apnea cured. I MY DS!
My doctor told me to stop having intimate dinners for four unless there were three other people. ~Orson Wells
Thanks again!
I met with my midwife last week for a routine exam, and mentioned that I am interested in bariatric surgery, and she was very supportive, which was a nice surprise. I made a point to have her note in my chart that we talked about it, just in case that would help at all down the line. She had a lot of good things to say about the program at Northside.
We have a POS through Cigna and according to the customer service department, do need a referral to see a weight loss surgeon, which is why I was wondering if it was possible to have a consultation without referral.
I'm trying to keep track of everything I can so that I'm ready at the end of the 6 months. To be clear, is it more important right now that I have my PCP documenting my monthly visits than moving forward with choosing which program/doctor I plan to use?
To your knowledge, are there a lot of psychologists/psychiatrists in Atlanta that specialize in bariatric surgery? Do they work in conjunction with the bariatric centers?
Thanks again!
I met with my midwife last week for a routine exam, and mentioned that I am interested in bariatric surgery, and she was very supportive, which was a nice surprise. I made a point to have her note in my chart that we talked about it, just in case that would help at all down the line. She had a lot of good things to say about the program at Northside.
We have a POS through Cigna and according to the customer service department, do need a referral to see a weight loss surgeon, which is why I was wondering if it was possible to have a consultation without referral.
I'm trying to keep track of everything I can so that I'm ready at the end of the 6 months. To be clear, is it more important right now that I have my PCP documenting my monthly visits than moving forward with choosing which program/doctor I plan to use?
To your knowledge, are there a lot of psychologists/psychiatrists in Atlanta that specialize in bariatric surgery? Do they work in conjunction with the bariatric centers?
Thanks again!
You're welcome to bring your child with you. Others have brought their children too. Just bring something to keep them busy, otherwise they'll get bored and restless ;-)
**** I AM AN OH SUPPORT GROUP LEADER ****
WHY I CHOSE DS: No dumping. Highest percentage of weight loss, Best long term results, Won't regain weight! Eat normal sized meals, 96% diabeties, 90% high blood pressure, 80% sleep apnea cured. I MY DS!
My doctor told me to stop having intimate dinners for four unless there were three other people. ~Orson Wells
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