TammyInIndy’s Weblog

Today’s Date: August 31, 2008

Sorry it has taken me a few days to write.  I have been extremely busy with work stuff.  So, to catch you up on my experience of last Thursday’s appointment….

I don’t know really how some places do their surgeon consult, but over at the hospital that I am going to be doing mine at (which is St. Vincent’s Bariatric Center of Excellence), our first appointment is a informational meeting where we get the opportunity to meet with the staff of the center, the nutritionist, the individual who works on getting the insurance approval work done, and the surgeon who we chose.  After the informational meeting, as I prefer to call it, if you decide you would like to proceed with the surgery (or would just like to ask more questions about the procedure to help you decide if you want to proceed) you meet one on one with the surgeon in a private consultation.  If you are self-pay you would pay for the fee for that consultation (not the whole surgery just the one-on-one) at that time or you pay your co-pay if your insurance company says that is what you need to pay.

My insurance company required that I pay a $15 co-pay for the private one-on-one consultation with the surgeon, however if upon approval for the surgery, and according to my insurance company, any future payments (or co-pays) will be covered for the surgeon and any other specialist at 100%.

According to our insurance (UHC) our plan (Choice Plus) only requires that it be a medical necessity to have this surgery.  But, even still if it required all the other things (40+ BMI, Co-morbidities… a word I can spell better than I can actually say..etc., etc.) I still would fall within the spectrum so having to prove all that is fairly simple in my case.  They gave me the sheet to sign to have my PCP send to me all the required paperwork that will need to be submitted to the insurance company (or at least the paperwork that they require as a center), so that should be coming before too long.

About the meeting itself.  It was rather interesting.  I am very glad I took Jason along.  I wanted him to be there so that he could hear what they were going to say about the procedure itself, what needs to be done before hand, and what life will be like afterwards.  The nutritionist talked about the differences in food portions before surgery and after surgery, the vitamins and supplements that will need to be taken for the rest of one’s life and their importance, how often one will come in for a re-evaluation of diet as one progresses after the surgery, and how as a WLS patient at that facility we can come in at anytime for free for the rest of our lives for nutritional counseling (insurance or no insurance).  The lady who will handle the insurance stuff talked briefly about the steps that will be taken to get insurance approval, and also to those who are on medicaid the more stringent requirement that medicaid has for people wanting this procedure.  She talked about how she couldn’t specifically say how long it could take to get approval as the insurance companies are very unpredictable on how long they may take.  Some may have an answer back within as little as 2 days some may not have a response back for a couple months.  She also discussed how if the insurance company does deny coverage they will work with you to get that approval by submitting an appeal.  She talked about how it is sometimes just a document that is needed, but sometimes it is a series of tests or 6 months of continuous physician assisted medical weight loss program.  The surgeon discussed the surgery itself.  She talked about the Roux-en-Y, the Lap-Band, and the Vertical Banded (which she does not do the Vertical Banded), and she also talked about a new procedure that she also does… but I forget the name of at the moment… hang on… I’ll go and look it up… Ahhh got it… Stomaphyx… that’s it.  She discussed the problems that can occur after surgery and how it is extremely important to follow the nutritional diet set up for us by them and to take the vitamin and calcium supplements every day.  How if we didn’t eat exactly as we were told then we could have problems with obstruction, and that certain foods and carbonated beverages can (and often do) cause heart burn and gastric reflux.  She discussed how when we move into solids we must make certain that our food is cut up into very small pieces and chewed well because if not it can cause obstruction.  If vitamins are not taken then the deficiency can cause major issues down the road, and not taking the calcium supplement can cause osteoporosis.  She made certain that we know that if there are ANY problems what so ever that we can call at any time 24/7 and they will let us know what we need to do that no complaint is too small of a complaint.  She let us know that she likes to follow her patients for life so then if we have any issue she would like to be there for us as our own personal surgeon so that we can always guarantee that some other surgeon down the road won’t botch up what we had done with this gastric bypass.  Something that to me is very important and great to hear because I like consistency.  My PCP has been my doctor for almost 18 years now and I prefer to have consistency when it comes to my health care team.

In the one-on-one consult the surgeon answered all my questions and gave us even more detailed information on the questions that Jason and I had on more personal matters.  She made me feel very comfortable and had a wonderful bedside manner… definitely not a “Dr. House”.  Jason had questions about his smoking habit and if that would be a major issue with her in regards to having the nicotine test that they also do before surgery.  She said no and that our having told her at that time is good because they already know up front and can expect that there will be some in the system from second hand smoke.  She did tell Jason that after the surgery it may be best to not smoke in the same room that I am in for a while so that I may heal faster, but she isn’t going to tell him that he has to give up something that he doesn’t want to give up… as he isn’t her patient, I am.  Her concern is that I am not smoking.  So that helped him to feel better… and yes he can just go in the other room away from me… as he has been doing anyway.  After insurance approval she told me about all the various different tests that will need to be ran, minus the gallbladder / gallstones test as I do not have my gallbladder so that test would be pretty useless for me.  She stressed that it would be good to start walking about 15 minutes, at least, every day because that seems to have a great affect on the healing post-op if it is started pre-op.  Walking is recommended anyway very soon after one is done with surgery as well.  In the hospital the nurses will have us up and walking for 15 minutes every 2 hours when we are awake and we will be required to wear hose so that to also help with any possibilities of blood clotting.

All in all, I was VERY pleased with her and the staff at the center / hospital.  Jason was pleased and felt more comfortable because he was able to get all his questions and concerns about how this will affect me taken care of.  He is even considering going to the support group meetings with me pre-op and post-op so that he can understand more (and it was suggested – but we will see if he actually will as he isn’t too keen on support groups).  His being just as comfortable with her, the staff, the support group… the whole thing… is important to me as I want him to not worry so much and I think it will help with any of those “issues” that we hear so much occurring within relationships after this surgery.

So.. What is up next for me??? Well… on the 9th of September we are going to our first support group meeting, on the 10th is my psych eval appointment, the paperwork from my PCP should be in sometime around then and the surgeon will have her letter of medical necessity done, as well my PCP is going to write something in support of this as well since he has been my PCP for almost 18 years it could have a great impact on the approval.

Soooo that is about it for now as far as an update with me.  I know this is exceptionally long, but I decided to add detailed information here for those who have questions. 

Have a great holiday weekend, everyone!

Tammy

Today’s Date: August 19, 2008

Today I got a phone call from Dr. Hess’s office and I scheduled that psych eval for Saturday, September 13, 2008 at 10:30 am. Her scheduler sent me an E-mail reminder and an attachment that has the directions & map. I would have liked to have that date done a little earlier, but hey… that’s okay; one step at a time. Besides, I got a lot of other things that I have to do as well so no need to rush this through.

I got my packet of stuff in the mail today from St. Vincent’s Bariatric Center of Excellence in Carmel. Some of the information I have already filled out because the information form can be found online at their website.

I wonder why it is that I never really tried to take the time to learn about something as simple as “protein”. Now… I know that protein is good for you, but I can’t believe that I had no idea that it is important to have so MUCH protein. When I mentioned this to Jason you would have laughed at the grin that was on his face. Uhhhh yeah, yeah… whatever! So now I am trying to find foods where the calories are low and the protein is high. Chicken, fish, eggs… okay… but I don’t want to have every meal be only these. Oh… forgot…. Prior to having this surgery I have to have a protein level test done. If that level isn’t at a good rate then the surgery will have to be rescheduled until it is up. I don’t want to have to do that so I am hunting down all the protein I can find…. Except for Jason (love him, but… ummm… no… not right now… goooo awaaaaaaaaaaaaaayyyyyy… you are bugging me!  – He is reading over my shoulder.) So back to what I was saying…. I am trying to find protein. Bought some water and a box of those little single serving drink mixers that has protein in them. Not too bad tasting, but even that is still only 5 g. of protein and I am reaching to get at least 80 grams in a day. That is just a number that I pulled out of a hat for myself to shoot for with the thought that if I can get that then I will be doing well. Ate a boneless skinless chicken breast for dinner and while that has 25 grams of protein… and it is tempting… do I REALLY want to eat chicken three times a day then 1 of those drink mixers 1 a day???? NO!!!! I could PROBABLY tolerate eating that chicken 2 times a day. Okay so that wouldn’t be so bad.. But I have to find sources for the other 30 grams of protein. Oh… and here’s the kicker that I forgot to mention… calories… I need to keep the calories low. I don’t want to eat 3000 calories just to get 80 grams of protein when I normally only eat on average 1800 calories a day. That would put me into food shock. I am going to do some research. I wonder if I can just buy protein supplement tablets (that are not the size of horse pills). That would be an ideal option to get even more protein in there. Uggggghhhhh Maybe I should watch it so that I don’t over dose on protein… is that even possible????

Multi-vitamins… okay so here is my last topic of thought for the day’s journal. I hate taking vitamins… again, partly because the pills are usually the size of horse pills. I have never been one that did very well at taking large sized pills… or even medium sized ones for that matter (heck even the round T3 size pills are hard for me to swallow). They make me gag. But, after taking this surgery I am doomed to take vitamins every single solitary day for the rest of my life. So, okay… it’s not such a bad thing. Vitamins are good for us. So I will just have to learn how to swallow (Ewww get off the sick thought!). I am trying to be serious and all you guys can think about is…… ANYWAYS!!!! While at Wal-mart yesterday I discovered something cool that made me VERY, VERY happy. Centrum Liquid!!  Yep this made me a very happy camper. A multi-vitamin that is in liquid form so that people like me can take it. I was excited. THEN… this morning… when I get up to take this very cool vitamin supplement…. If you have never taken this liquid let me just say the color of it is very simply (and not meaning to be gross) a stomach bile yellow. Seriously it is. There is just absolutely no other way to describe it. So here I go down the hatch with this idea in my mind of what the color of it reminded me of. The taste… well… have you ever held a aspirin on your tongue for longer than you really wanted to and you get that chalky ikky taste from it? That is the taste of it… mixed with Centrum’s slight attempt at “tropical” flavor. But, I keep reminding myself what I am doing this for. What my goal is. And for all the powers that be I am going to get used to taking this vitamin supplement.

Tammy

Today’s Date: August 18, 2008

Well… today I got a telephone call from Lindsey @ St. Vincent’s Bariatric Center of Excellence. It was a very interesting conversation. She took down my insurance card information and talked with me about what the insurance company had told me about coverage benefits and criteria that they require for my particular policy. She is going to let me know if they tell her anything different since I was told by 2 people this information, but for right now this is great news! She gave me the name of a Psychologist that is approved by their program to do the psych eval that will have to be done. Lindsey is also going to send me out the criteria guidelines that Dr. Hess (psych) will have to use for following in their eval.

After I got off of the phone with Lindsey, I put in a telephone call to United Behavioral Health. Mary was a great help. She gave me my authorization number for Dr. Jacqueline Hess to do my pre-operative psych eval. Dr. Hess is in our network and our Co-payment is $15. Dr. Hess practices with the “Community Psychological Consultants”. I tried to put in a telephone call to her office but got no answer. Got a voice mail. I left a message for someone to return a telephone call to me as soon as they could. I will call her office again tomorrow.

Tammy

Today’s Date: August 15, 2008

TC to United Healthcare (UHC) to check on the requirements that they have listed for the surgery. Megan said that while some policies have major requirements ours does not. Our policy’s major requirement is that this is a medical necessity. She could not give me what the requirements were for other policies (such as a BMI of 40, etc.) as our policies only requirement is that it is a medical necessity. She said that once they get in the packet of information for the board to review and if the board is in agreement then our benefits, as Lynn had stated to me on the 12^th, is what they will be.

Called St. Vincent Bariatric and they said that they still have not gotten the fax from Ellen at My PCP’s office. I did let her (Heather) know what I had just found out from United Healthcare and let her know that the only reason I was checking on that is so that I knew and so that I could help them to help me be proactive in getting this done and in motion.

Telephoned my PCP’s office to talk to Ellen at 2:45 pm left a message for her to return my telephone call. The fax number that she sent the stuff to for St. Vincent Bariatric is under fax number: (xxx) xxx-xxxx.

Telephone call to St. Vincent Bariatric. Told Heather the fax number Ellen sent the information to. She made note of that and said that is the main fax and that they get tons of faxes in there in a day, but that the info should be coming to either her or “Amy” soon. I set up an appointment to see Dr. Gupta ( http://www.carmelsurgicalspecialists.com/ ) on August 28^th at 4 pm. and Heather said that I need to plan that I will be there for about 3 hours at least. So… okay… here we go… YEAH! Heather said that within a few days someone will be calling me to get some additional information and then send me out a packet of information that I will need to complete. August 28^th…. The beginning appointment towards a change!

Tammy