newbie with questions

Hi, I just recently made the decision to get gastric bypass surgery. I made the appointment for my initial orientation (11/21/06) and I have a couple of questions. First, has anyone had experience dealing with NYS Empire/United Health insurance? Second, what should I expect as far as pre-testing requirements? thanks

First of all, congrats on your decision. As far as your insurnace, I can't tell you. But for the pre-testing...... Every surgeon is different and has different requirements as well as the ins co. You have to check with them first. See what they cover and if the have any requirements prior to an approval. Such as a weigh loss befoorehand. A 6 month diet plan supervised by your PCP. Once you get that and you go for your consult, the surgeons office will let you know what pre-testing you go through. Marie

Janet: Hello! I see by going to your profile that you will be using Albany MEd as your Bariatric program! I can not say enough positive things about both surgeons Dr. Rosati (who only does the RNY as an OPEN procedure) and Dr. Singh (who does the RNY open but prefers Lap and does the Lap band), both are professional, very compassionate and experienced! Although each insurance company has its own requirements for surgery and each bariatric surgeon has his own criteraia for preop testing, in AMC it is common to first go to Clinical Nutrition for educational classes, a 10% standard preop***see beloe*** wt loss goal before meeting w the surgeon, Upper GI endoscopy w/ Dr. Singh (I believe Dr. Rosati does his in OR befoe surgery), clearance from PCP, Labs, GallBladder ultrasound and a psychiatric evaluation. Other clearances may include based on medical comorbidities: Sleep apnea study/pulmonology consult, cardiology, endocrinology, hemetology, gastro (if liver issues) etc etc. It is tailored to the individual which is nice! SOme insurances require a 6 month or 12 month MEDICALLY SUPERVISED AND DOCUMENTED MONTHLY BY WEIGH INS WT LOSS FAILED ATTEMPT! ****************** WT LOSS BEFORE SURGERY/MOTIVATION/AVOIDING THE LAST SUPPER SYNDROME In our program we are required to loose 10% of our body wt before surgery.... Loosing weight pre-op is required by many surgeons & for many reasons... and I am so happy I did! 1.. to show motivation, 2.. ability to adhere to a plan (as we will need to for life!), if you can't be mindful and able to follow restrictions pre-op how will you do it post-op? 3.. to increase your health even a modest 5-10% wt. loss is very helpful, the National Institute of health has even researched this...(hence why weigh****chers is so focused on the 10% wt loss) 4.. decreases surgical complications (by exercise and decrease wt your heart and lungs are in better shape for surgery, anesthesia and healing!)... 5.. Also psychologically it is tough going from a super-sized big Mac meal to clear liquids for 2 weeks post-op! 6.. ***MAIN ONE FOR PROTEIN SPARING or MEDIFAST DIETING***It helps shrink the liver and this eases their surgical procedure and decreases chance of nicking it.... 7.. exercising before helps you continue after! 8..The more you lose pre-op the less you will have to lose post-op and the closer to an ideal body-wt you will attain! I lost the weight by doing the food pyramid. That's it, I was eating so bad (fast food daily, large portions, consuming every high-fat/sugar thing imaginable and NOT exercising that just cutting down and walking 2 miles a day helped! For ME, it was "no one" was going to stop me from having this operation, it was my decision and all that was asked of me was to loose 30 lbs, I figured this is a small price for such a wonderful gift I would be given and the opportunity to have a healthier happier longer life....! I was so motivated/psyched; I dropped 30 pounds in 30 days and went on to drop 15 more before surgery! (Although this took me 2 months, as it got harder and I had a few last meals, we all do but you can't let this ruin your opportunity!) Exercise was another key; I faithfully walked 2 miles everyday..it helped that my mom went with me a lot! (a buddy is so helpful!) I followed the food pyramid given to me by clinical nutritionist Dr. Boham...I also wrote everything down (Many find www.fitday.com helpful for this) that went in my MOUTH!!! Or you can get food pyramid/bullseye version at: http://www.xenical.com/hcp/1400_Am_Beye.pdf I also had to remind myself how BAD I wanted this! Everyday it was/had to be more important to me to change my bad habits and lose weight to have this surgery than to continue to slowly kill myself with food/keep myself from the only hope I had!. I also told everyone about my plans and they helped support me, my friends/family and coworkers! I really can't give you any more guidance than this, it really had to come from within, it was a mindset with me, and I wanted this BAD real bad and I knew it was my last resort/chance! I felt invigorated and motivated by the end results...the long-term had to outweigh the short-term gratification of eating bad choices or overeating! It was a learning opportunity for me to change my habits and practice chewing well, not drinking with meals and eating smaller portions, giving up sugar/caffeine/carbonation/alcohol (if any of those are your issues, carbonation/caffeine/alcohol weren't issues for me)! So a few weeks/months of healthy habits to lose pre-op wt is not a lot if you frame it right! IT IS NOT FOREVER and it is about starting this journey! ********************* I recommend calling your insurance carrier asking for a copy of your policy in regards to Bariatric surgery so you know exactly what is what! Are you wrking w/ Albany Clinical Nutrition, Dr. Jill Braverman Panza's office or Dr. Alger at AMC (The 3 clinical nutrition offices used/accepted)??? Albany Clinical Nutrition 1240 New Scotland Road Slingerlands, NY 12159 (518) 475-7000 X4 Vanessa Denning, MD Ann V. Michelek, MD Barbara Kapuscinska, MD Carol R. Santoro, MD Ellen Goke NP Kathleen Callahan RD ~~~~~~~~~~~~~~~~~~ Jill Braverman-Panza, MD. 1375 Washington Avenue, Suite 202. Albany, New York 12206 518.482.0007 *I do not know if she accepts new pts?* ~~~~~~~~~~~~~~~~~~ Dr Sharon Alger at AMC 262-299 2 Support group meetings are required: AMC has one each Thursday 6-8pm in Dr. ALgers office lobby (go in AMCS white pillar entrance on New Scotland Ave and take FIRST Left before the info desk, down the hall) Ilana Nardone is a RD who runs those groups.I believe they have an answering machine system to call in case of cancellations/inclimate weather (518) 262-2195, Albany Clinical has one each Tuesday 5-7pm in their Slingerlands office lobby as well run by the Dietician Kathleen Callahan [email protected] . They also have 2 educational classes you must attend I believe $50 each? I try to keep up but things do change often. I run a local suport group in Saratoga 1st Monday of the month 6-8pm in the Saratoga Hospital Boardroom. Website groups locally: http://health.groups.yahoo.com/group/SaratogaSprings-NY-WLS-support/ http://health.groups.yahoo.com/group/ACN_Bariatric_Surgery_EducationGroup/ http://health.groups.yahoo.com/group/upstatenywlssupport/ So basically the gatekeeper is CLinical Nutrition they help guide your journey and preop req. Meeting w/ both surgeons is optimal to get the most informed and educated decision you can! Other ? Please email me [email protected] I will send u a handout on dealing w./ difficult people who think this is the easy way out! GRR (one of my pet peeves!) It takes extraordinary courage to consciously limit food choices for the rest of your life (and potentially limit social opportunities built around meals). For many patients, life after WLS means treating food as a fuel, not as a source of drama, excitement, comfort or a central life focus: i.e. eating to live rather than living to eat. While some procedures may be reversible, for most patients WLS is a lifetime commitment, requiring a lifetime of major lifestyle changes. SURGICAL SUCCESS REQUIRES THAT THE PATIENT INITIATES AND MAINTAINS DRAMATIC HABIT AND ATTITUDE CHANGES.....THIS IS NOT EASY ASK ANY POSTOP GREATER THEN 1 YR OUT!!!! (*and even for some only minutes out!) HUGS dear you will find your way on this journey if it is right for you NO ONE ELSE! Take Care, Jamie Lap RNY 10/9/02 Dr. Singh 320/163 5'9'' (lost 45# before surgery) Plastics 6/9/04 & 11/11/2005 Dr. King http://www.obesityhelp.com/morbidobesity/members/profile.php?N=c1132518510 "Being happy doesn't mean everything's perfect, it just means you've decided to see beyond the imperfections!"

WOW. Thanks for the information! I knew that I was going to have to lose the 10% so I have already started on that. The hardest part for me is going to be the exercising I think because I have arthritis in my knees and hips, but I am still going to plug away. (I am hoping that the wieght loss will help with this) I was thinking about joining Curves, but haven't decided yet. This surgery is something that I have thought about for a long time. I was not ready before, but and I am definitely ready now. I am so excited about having an opportunity to finally change my life. I have already lost 3 lbs, not much in the scheme of things, but a start. Thanks so much for the encouragement and support! I will keep you updated on my nutritionist as soon as I find out who it is. I don't go to the orientation until 11/21.

Hi Janet, Jamie, who posted above me was the one who originally sent me the email with the tons of links re: weight loss surgery that I told you about on Saturday eve's chat. I am emailing it to you via your OH email. Jamie is a fabulous resource re: WLS questions! Please feel free to email me with any questions. Hugs, Amy

Thanks Amy, So glad I found this sight. Everyone is so nice and supportive. It makes this journey even more exciting.

Janet, Congrats on taking these first steps to this crazy and wonferful WLS journey... I wish you all the best hun and if you have any questions please feels free to always post and ask. This is a great group of people here and they are always so very caring and supportive. As far as your pre-testing, as Jamie said, every Dr if different and you will just have to see what they say when you go to see them, also you can call your Ins company to see if you can get them to give you what is needed, sometimes they work well with you but others they do not and you have to let the Dr find out. I wish you all the best!! Debra P

I actually decided to call the insurance co today to ask some questions. Some good news, some not so good. They said they will approve the surgey because my BMI is 40, however they do not cover the nutritionist unless I am diabetic, which to my knowledge I am not,. I know that is a major part of the process and I am very concerned about that. I refuse to let this get me down...I will talk to the people at the hospital and see if there is anything they can do. Thanks for the encouragement and support. Janet

Janet, Since everyone else had such great posts I figured I would reply about the nutritionist. My insurance did not cover the visit either but they did cover me seeing the nutritionist at my local hospital. Since the hospital did the billing they covered the visit and I only had to pay the co-pay. You may want to see about doing it this way and see if they would pay then. Good luck and congradulations on your decision. Bob

Thanks Bob, Your post gives me some hope. I was also researching the insurers pages and every single one with my insurance was approved and only a handful had any problems at all, so I am feeling good about it. I just wish next Tuesday would get here already! I am so anxious to get started! :-)