Hi, I'm new here and am contemplating surgery and need advice.

Hello everyone. I'm embarrassed to say that I haven't ever been on a forum, so I have just tried to get acquainted logistically for the past week. I am seriously contemplating surgery at the pleading of my cardiologist and support from my pcp as well. I'm closer to Columbus but between Cleveland and Columbus. I am looking at Riverside and Cleveland Clinic currently, just researching online. I have a Medicare assigned Anthem PPO, which is new to me this year. When I inquired whether this is a covered surgery, they gave me coverage for any inpatient surgery covered except for $270/day til day five and then at 100%. I intend on inquiring again, as the plan coverage booklet is very vague. Can someone give me insight on a particular hospital. I have heart and lung disease, sleep apnea-Bipap, htn, high chol., use o2, and am on disability due to a back injury and my rom is limited. I am anxious to gather as much info as possible. Thank you in advance for any input you may have.  And...thank you all for putting your own stories out there. You are all very courageous.

Hello,
Congrats on deciding to investigate bariatric surgery.  I think to start out, the most important thing would be to get clarification from your insurance company if they cover the surgery.  It doesnt sound like you got a very good answer from the insurance company.  Once you know what surgeries they cover you can go from there.  I had surgery at the cleveland clinic with Dr. Schauer, but my insurance required me to document 6 months of supervised weight loss.
The first thing after you clarify with your insurance company would be to sign up for an informational session and get all the facts that you need for a decision.

Good luck and keep in touch,
Susan

Dear Susan, Thank you for your kind reply. Yes, I intend on doing that first thing on Monday, (Call my insurance and clarify coverage). I was not confident with the info that they quickly spouted to me when I called about an unrelated question the other day. She simply came up with it too quickly. She didn't do any checking, and I have known them to be wrong before when arriiving at an answer this quickly. My other thoughts are...my husband is currently layed off from work and has been going to school. So, I am hopeful, now that he is out of school, a job offer is on the horizon. This private insurance as primary and medicare Anthem as secondary. And-when I can change my Medicare insurance in December again, I am going to be. In the mean time, I want to be doing all my preliminary things I possibly can. Perhaps get started on the six month program for one thing. 2.  How many visits prior to, and then after, surgery? 3. Is there a specific diet you had to be on per the clinic, prior to surgery? Do they require you to come up with anything NOT covered by your insurance PRIOR to surgery? Like, Riverside says something about- on your final pre-surgery visit, you need to have the last of your "post surgery" care financial obligations met *** what?) Although I am disabled now, a sledding accident left me with the bottom 4 discs in my back crushed, requiring 4 rods and many bolts and a fusion that left me with little range of motion, I have also had many other health issues as well, including an esophageal nissen fundal plication and a gallbladder removal (laparoscopic with six incision sites), a pain pump implanted, which will be placed for the third time, come next week. It's an intrathecal pump; so it's implanted in my left flank but has a tubing that goes over to my spine. Also, I have had a tubal, c-section, tubal, and hysterectomy; so-with all those abdominal surgeries, I don't know that they will do a(n) RNY, so, perhaps a sleeve is better initially, until I loose some weight to improve my lung and heart issues, then adapt to the RNY, based soley on what I have researched. Thanks again, Susan, for your response. Respectfully, Carolyn-buckeyebaklava

Wow!  You certainly have been through a lot!  I am curious if it is possible to do the RNY after the nissen fundal plication, but if anyone would be able to do it, that would be Dr. Schauer from the Cleveland Clinic.  He does many complicated bariatric surgeries that other doctors wont attempt.

For the supervised 6 month diet, I only had to go to my primary physician and he kept a record of my visit each month.  He recorded my weight and any diet strategies that we had discussed. 

Keep me posted,

Susan

I also wonder about the nissen. Perhaps with that small of a stomach, it will no longer be necessary. In that case, they can snip the stitch; there is only one. But I don't know. Also, with all of those abdominal scars from so many surgeries, I dont know whether they will do it. And finally, I am concerned about that intrathecal pain pump. They will really have to watch out not to nick that catheter going over to my spine., If not....it will lead to that medication spilling into my abdominal cavity but worse than that, spinal fluid leaking out of the other end. I am wondering if this will cause an open surgery due to pain pum***** help at all. Perhaps I should ask to speak to someone in the office to give them a history of my thiryfive surgeries and current health decline and see if that will disqualify me before I go any further., I see you are almost at your goal. I must say, I am in awe of your journey! I'm SURE it was quite a long road. I have a set of twins that will be 20, May 21st and they will also complete their freshman year in college the same week! They both go to the same college MVNU, a Christian college in Mount Vernon. I want to see them graduate and start families. I tried for so many years to have them and finally succeeded. Along with my husband, they are truly the loves of my life. Thanks to fertility meds and many many surgical procedures, we had them, first and last. I want to be around to enjoy them getting their own families. I need to get rid of the health issues that obesity has brought with it. Thanks for your response.,again! I hope you are hitting your goal soon! Carolyn

 If I was close to Riverside I would go there to Dr. Tom Sonnanstine.  He takes patients that no one else will touch and he is very caring and will be with you every step of the way.  He did my second surgery which was RNY and I just couldn't believe the difference in the care I received from him vs. what I had received when I had my lapband with a different doctor.  

If you have medicare it will pay for weight loss surgery and actually you are not out of pocket that much.  I have plain ole Medicare, nothing else and it paid for both the lapband and the RNY.  I did not have a waiting period, just had to attend the classes and the pre-op work and I was ready to go.  With my lapband I started the journey in April and had surgery in August, with my RNY I decided to have it in Oct and had surgery in January.  I could probably have had it earlier but wanted to wait until after the holidays and after my sister had quit her job.  My father had alzheimers and I had to wait until she could take care of him for me.  I had a small probably after surgery, but Dr. Sonnanstine was so good with it and to me.  I plan on doing my follow up with him in Sept.  I saw him in Sept before he left KY so I am not going bac****il it has been a year since I have seen him due to it being about a 6 hour drive for me now.  

Jacqueline,
     Thank you so much for your reply. I do hear good from him-Dr, Sonnanstine. I took the online seminar that Riverside offers. It was very informative. He appears on the seminar,  to be a very approachable physician, and kind.. I dont currently have straight Medicare, I have a senior advantage and hate it. I felt rushed this year to decide and got very sick after a hospitalization and my potassium got very low. I was pretty fuzzy with a 2.3 potassium and was miserable as I was picking a new insurance; a very bad selection on my part. They told me they have no requirements to fulfil prior to surgery and that I will responsible for a fee of $275 for the first 4 days of inpatient status but after that, they cover at one hundred percent. But I feel like, if I get started on certification right now...will I not be "up to bat" before my insurance changes. I did copy off paperwork to fill out for Riverside's program. I am actually much closer to his home town of Marion, but about an hour or so from Riverside.
      Did you have a lot of health issues to begin with and if so....how have those conditions improved? I am doing daily research and looking inward to get the confidence to go thru this process. I am sick and tired of being sick and tired. I intend of calling tomorrow (Riverside), to give them my insurance so that they can give me a better look of what Anthem will and/or will NOT cover and what will I have to come up with on my own prior to surgery-exactly. I dont want to advance thru a program to find out that I am responsible for fees prior to my insurance even is. Well,  your pics are very impressive as far as your obvious change. May I ask you, were you having trouble with the lap band, ,and that lead you to the RNY?
     Thank you so much for your reply, and continued sucess in your journey.  

 Sorry it has taken me so long to get back to you.  I am in the middle of remodeling my  house and needless to say I forget lots of things.  

Health wise,  I had already had knee surgery but not a replacement, I had sleep apnea, diabetes, on insulin and pills, high blood pressure and high lipids, all has resolved, except my knee pain and it is not near as bad as it use to be but when "ole' arthur" flars it is very painful and I am sure you know there are certain medications we can never take again. 

About my band?  I was starting to have problems but just could never lose weight even by following all the directions.  

Hope you have found more information since I last wrote.  If you do facebook you can facebook me by typing in Jacqueline Coldiron.  

I did not know about the medications. Like What meds can you NOT take? Now thinking about this...I would suppose this us due to malabsorbsion, correct?

 substained release medications you can't take because you won't absorb them, but aspirin and ibueprofen because it can call ulcers.  I don't know if you have the medication issue with the sleeve or not, but I would suppect you would.  My insurance wouldn't cover the sleeve and I don't know if medicare covers it even now, but I am thankful I had RNY because I am not a fast loser and don't think I would have gotten as much off as I wanted, nor have with the RNY but it will come, slowly but surely.  It is up to me to work the tools given me.