New to this.... again. I have a few burning questions:

I have been on this site and receiving emails from OH for years.  I had called for and received the bariatric surgery packet from Salem Hospital twice.  I just filled it out and actually mailed it last night, so I am further than ever before.  I have a few questions though, one specific for State of Oregon workers.

1)  How long should I plan to take off work?  I will need to bank some comp time, I'm sure.  I just need to know how much.  How long will it be before I can go  back to work.  Which is sedentary, I don't do anything real physical.  This is based on a normal recovery after surgery and no complications.

2) Who has PEBB Providence Choice insurance and did they approve the surgery without a whole history of trying diet drugs from your doctor?  I was reading that the usual reason they don't approve the surgery is the lack of weight loss history from your doctor.  Thing is, I still have a weight problem and I have tried a hundred different diets, just never wanted to try the drug route.  Doesn't mean I haven't tried weight loss, just never with drugs.

3) How much does a surgery usually cost, if insurance doesn't approve my surgery and I have to pay for it myself.  I am thinking about the financing option Salem Hospital provides.  But I need to know if it's doable. 

Thanks you in advance for any insight or advice you can provide.

Thank you!

Hi there,

I can't answer all your questions, but I'll try to give you some info.  Time off for the surgery will depend on how strong you are before surgery.  I'd recommend taking up a regimen of walking as much as you can to get yourself as fit as you can beforehand.  It really helps.  You'll need a minimum of 2 weeks off after surgery.  I think that's all the time I took.  I was a secretary, and didn't do heavy lifting.  I was still plenty tired when I went back, but it was do-able.  

As far as insurance, I was a state employee, but at the time I had surgery, our coverage was with Regence Blue Cross/Blue Shield.  I got approved easily and had my surgery, all was well with yearly check-ups, etc., even when state coverage eventually changed to Providence.  However, once I retired and got switched to PERS retiree's insurance with Providence, I found that they cover absolutely nothing to do with bariatric surgery.  I have a complication and need a revision, and I'm up the creek without a paddle.  So - be careful with that situation.

I'm not sure what the cost of surgery is nowadays.  I had my surgery 7 years ago.  Costs will depend on whether your insurance will pay or if you pay yourself, and if you pay up front, you usually get a big discount.  This will be something you should address with the surgeon, perhaps on your first visit.

Best of luck to you!

Hi Linda,

I'm also a retired state employee with Providence PERS and expecting to have my surgery covered. The Group Plan Reference guide says prior auth is required for bariatric surgery. See page 17 in the following PDF.

https://healthplans.providence.org/pdfs/medicareplans/documents/group-plan-reference-guide-2014.pdf

There is no mention of the surgery not being covered.

Hope this helps,

Patty

I don't know about PEBB or Salem Hospital, but I just went to a consult at PeaceHealth Bariatric Center here in Eugene and the total estimated cost for pre op/surgery/post op was around 40,000. My insurance only covers 50% up to a maximum of $15,000 per lifetime!! I had no idea it would cost that much. If you find out how much it is at Salem Hospital let me know!

I would suggest you check with Bay Bariatrics. They sent me a packet in the mail and its not nearly that  much. Also Dr. Tersigni is awesome. My pharmacist says everyone from Douglas County has never brought him prescriptions to fill from anyone other than Bay Bariatrics. It lists the cost as $25k for most of the surgeries. Just a thought. ----

Bay Bariatrics is accredited by the American College of Surgeons and the American Society for Metabolic and Bariatric Surgery as a designated center for bariatric surgery. This prestigious designation demonstrates our commitment to safe, high-quality surgical care and continuous quality improvement. Only a handful of surgery centers in Oregon have achieved this designation.

Call us today at (877) 639-9968. We’re here to help!

Just an update, I didn't get into Salem's bariatric program but did get into Legacy Weigh and Diabetes Institute in Portland.  I have been to the first meeting, the welcome group and look forward to my dietitian, psychologist, physical therapist and nurses appointments.  PEBB Providence appears to have approved the surgery, and I have been authorized for 1 year's worth of appointments.  I also called Legacy prior to actually being accepted and they had already submitted for the surgery authorization, which I must have received since I am now in the program.

They require a 5% weight loss before surgery, should be about 20lbs and per Providence, I have 6 months to do it.  If not within that 6 months, the authorization terminates.  I am not sure how much of the surgery they will be covering and I have been advised to contact them.  However, I have tried that and got the "we don't cover that surgery" answer.  Perhaps I need to word it a certain way?  I am not real sure, at this point, it's something to look into.

Legacy does the surgery laproscopically so I am hoping that it is a minimal down time.  I also have a very sedentary job, so I could probably go back quicker than if I had a physical job.

Before being accepted, these questions were on the top of the list, however, now I have several more.  What a journey this will be.

Thank you all for your replies.

Hi Keeks! I was also rejected by Salem Hospital and am approved to start the process with Legacy. We may run into each other!