Just starting and overwhelmed.

Hi everyone. I am completely new to the forum and at the beginning stages of weight loss surgery. I have been looking into surgery for years but each time was told that my insurance wouldn't pay. I FINALLY have insurance that includes bariatric surgery and completely thrilled. I am also so overwhelmed. I have my intake appointment on Nov. 4th and by that time will have Aetna HMO. I want to make sure I get the right surgery and will be doing it @ Abington Hospital because I live in Philly. Anyway, any advice would be greatly appreciated. I am currently around 320 and 5'9. My highest weight was 347 and my goal is 160.

Your insurance company may authorize either band or RNY, as this is pretty typical. You'll likely get a variety of post on which surgery is best.  There are other surgeries too, but your insurance company will likely "stick to their guns" and only authorize those approved surgeries.  I had the RNY and will tell you that wt loss progresses at a faster rate than the band, and has less complaints and complications. There can be complications with any surgery.  Plugging your numbers into a BMI calculator, it appers to be over 47.  Most insurance companies require a BMI of over 40 for RNY surgery. If BMI is under 40, then you'd have to have 3 comorbidities, like high bp, sleep apnea, diatetes, etc.   As long as you don't have to take daily NSAID meds (like Celebrex, etc.) for joint pain, arthiritus, etc., the RNY may be a viable options.  I would recommend you check with your membership services of your insurance company to get details on bariatric surgery requirements. You'll likely have to get a referral from your PCP to start with. If your PCP is not "bariatric friendly", then you'll need to find a PCP who is. You usually need the referral to start the process.  Many insurance companies also require some form of medically supervised wt loss attempt. My insurance wanted a med. supervised program of 6 months duration within the previous 5 years.  If you've done this with your other insurance company, then you'll need some verification from your other doctor for proof. Otherwise, you may be required to participate in another program within your current insurance company. Call your insurance company to get full details of what they require. DAVE

Welcome to the forum.  There is a lot of great advice here.  Look around the different forums, explore different surgery types, and read as much info as you can find.  Ask questions, and don't get discouraged! 

If you haven't had at least 6 months of physician-directed weight loss visits with either an MD, nurse practitioner, physician's assistant, or registered dietitian, I would suggest that you start that ASAP (you still have a week to get an October appointment in before the end of the month).  The reason I say this is because most insurance companies require that, along with many other hoops to jump through, and the sooner you start it, the better.  They are specifically looking for things to be documented in that visit note such as:  date of visit, your weight at that visit, the specific diet you are following (1500 calories, South Beach, Weigh****cher's, whatever...), exercise you may be participating in, and the visit must be specifically stated as a "weight management" visit or reason for visit needs to be "discussion of weight loss attempts", that type of terminology.  You can't combine the visit for a sore throat, sprained ankle, etc., with a weight visit, it must be dedicated as weight related.  AND the visits must be consecutive -- you cannot miss a single month or you have to start the process over.

I'm telling you this for 2 reasons.  First, as a patient, I can tell you that I was denied by my insurance and had to fight appeals and STILL repeat 2 of my visits for weight loss because the documentation was not perfectly stated as a weight loss specific visit.  So my 6 month process took me over 8 months to complete (closer to 10).  Second, I am telling you that I currently work as a bariatric navigator for a bariatric center of excellence.  My job is to work with preop bariatric patients to help get them through the process of getting all the required documentation, visits, clearances, etc., together so that they can get their claims submitted to their insurance for authorization and then (hopefully) get approved for surgery.  Failure to provide that 6 month weight management visit info is one of the ONLY reasons that we have seen patients get denied by their insurance companies.  The other reason is usually that the patients' specific policy has an exclusion against weight loss surgery -- something we can't do anything about.  SOME companies don't require it ... but most do, and sometimes they even require more than 6 months, but the average requirement is 6 months.

So do your homework, make sure you are armed with all of your records, visits, clearances, etc., and best wishes!  

There are four forms of WLS---research them all. They are, in the order in which I would choose to have them:

DS/duodenal switch
VSG/Sleeve
RNY/gastric bypass
No surgery
LapBand

The RNY is the most commonly performed procedure, and probably the easiest to get insurance approval for. The Band is the least effective procedure, with the highest rate of re-operation---do NOT fall for the idea that it's "less invasive" and therefore safer. (The SAFEST WLS is the one that works the best FOR YOU.)

The Sleeve merely reduces the size of the stomach, restricting how much you can eat at one time. (No WLS will keep you from grazing.) The Sleeve hasn't been around as a stand-alone procedure long enough for there to be a lot of long-term data, but it looks like it will prove to be about as effective as the RNY, with fewer potential complications.

The DS is the most effective form of WLS, especially for people with higher BMIs. It has the very best long-term, maintained weight loss, and it has the best stats for resolving or preventing co-morbs like diabetes, PCOS, insulin resistance, high cholesterol, etc. It has essentially the same stomach as the Sleeve ( retains the pylorus and all normal stomach function), plus an intestinal bypass to provide permanent malabsorption of CALORIES. The post-op eating plan for the DS is the most liberal of any WLS.

No matter what your insurance company syas they cover, research them ALL. Insurance companies can be forced to cover other surgeries, when people are willing to fight. And if the surgeon you're currently seeing doesn't perform the procedure that you think is right for YOU---find a different surgeon. This is a decision that will affect the REST OF YOUR LIFE. Think twice, cut once.

Visit the Revision board and see what happens when you choose the wrong surgery:www.obesityhelp.com/forums/revision/

Good luck to you!

..

Welcome! And I agree with MsBatt on everything she said.