MSinger

Hello all, I found out through my insurance that they will only approve VSG as an outpatient surgery going forward. They used to approve 1day inpatient at the same time as the surgery review. I'm feeling nervous as I don't think it's reasonable to expect people to go home on the day of surgery, plus, when I spoke with my surgeon he told me to expect a 2 day inpatient stay and that he usually does not find himself discharging patients on POD1. Like most people, I've read case after case of VSG surgeries and I have yet to come across a person who went home the same day. My impression was 1 day inpatient was reasonable, and of course I'd understand staying inpatient for a second night if my pain or nausea was out of control, or I was not tolerating fluids. Has anyone done VSG as an outpatient? If you stayed inpatient, how did you feel right after surgery? Did you feel like you can go home that night?

Please don't take what I say as bible truth, but I review surgeries for a major insurer (not Humana). For my company, if there any policy changes, they would go into effect from the day the new policy was published. Up until that day, the old policy will apply. The issue of a request being submitted shortly before a change in policy is something we have never explicitly been told how to handle. In the end, it may be up to the insurer. I'd say, if you have all criteria met now for the current policy, then submit now. An approval cannot be "taken back" once it's been issued. My company issues approvals that are good for one year for the line of business I handle. Some lines of business have 6 month approvals. And of course, it may be different for other companies. In any case, My suggestion is if you meet criteria and are denied for the basis that you don't meet criteria for the future policy, then appeal that decision. It is almost always worth it to appeal a denial since I see so many denial decisions overturned. The only hard stop I know of is if a group does not cover bariatric surgery. Other than that, it's always worth pursuing. Hope this helps.

Ugh.. I am almost certain I'm gonna cry at some point during the preop diet. This really is TOUGH. But I told myself before I started that this will be hard. If it's smooth sailing, then I'm doing something wrong.

Getting my nails done is an excellent idea, thank you for suggesting it!

I'm currently going through the preop process. I met with a nutritionist at the beginning of last week, and she wanted me to practice the post op diet.. pretty much what I'll be eating from 3 months out of surgery and for the rest of my life. The plan is to meet next Monday and hopefully, I'll be done with all my pre-op requirements. I'm trying. I started gradually decreasing my fat and sugar intake, threw out massive amounts of food that I will not be eating, stocked up on Protein shakes. It's going ok, but I am SO cranky. I get that detoxing off sugar can make a person snippy, I just think it's a combination of sugar detox, having to change my eating pattern, reflecting on my history of poor food choices, and mourning. I gotta say, I am not a fun person to be around right now. I'm determined to get through it, but for now I feel like I need to warn people.

I'm trying bit by bit every day. It's been hard because I'm having nasty sugar withdrawal headaches. Plus, I have to change up my poor habits. I did well yesterday at my mom's house, but not so great today. Also, i've been cranky and I'm having trouble concentrating on my work. My goal for right now is to cut out sugars and keep my carbs to under 150g/day so hopefully when it's time for me to start the preop liquid diet I won't be a total mess.

I am seconding Premier Protein. That shake is by far the best brand I've ever had. As long as my taste buds don't change post op, I fully intend to keep drinking them once a day as my diet advances. They are that good

During my nutrition appointment, I was given a brochure for a company called Nutrition Direct. They bill insurance and charge you $25/month for a month's supply of bariatric vitamins which is delivered to your door. I looked at their site and will probably go with these guys (if I get approved for surgery), but I'm a little unhappy about the hard sell I feel I got. I told my nutritionist that I *might* be interested, but would look over the materials myself and let her know for sure at my next appointment. All of the sudden, I get daily calls from this company. I looked at their site and this seems like a good service, but I didn't agree to enrollment. Maybe that's an issue to take up with my NUT, I don't know. www.nascobal.com

I'm still pre-op, but I take daily vitamins and have a pretty good system going. Basically, I figured out what time of day I'm most likely to take them, and where I would be at that time of day. I hate taking my multi in the morning, and usually forget to take my vitamins before bed, so I take them right after I get off work. I work from home and keep all my vitamins on my desk, so when I'm logging off work, that's my queue to take them.

I don't have an answer to your question, but I do hope your Dr's office will pursue peer-to-peer and appeals. I work for insurance and have seen plenty of decisions overturned. It's always worth a shot. Good luck!

I'm pre-op, but I watch the show as well. Even though many of the patients are twice my weight, the food struggles are so relatable. Plus, it's interesting to see the family dynamics, and how they contributed either by enabling or by being abusive. I also find it helpful to watch the episodes with noncompliant patients, because it helps me see some of the unhealthy rationalizations they use for why they're failing. Some of those folks construct elaborate "woe is me" delusions. They'll put away a plate of mexican food, then swear up and down they followed the diet 100% during their follow-up visit.

Good luck!

Hey all, I had my initial evaluation this past Friday, had my labs, chest XR, and EKG done. A few of my labs came back abnormal. My A1C level is 6.1, which now puts me into diabetic territory. I'm not happy, but I can't say it was totally out of the blue. I've been hovering in between 5.5 and 5.9 for some time and diabetes does run in my family. I've also put on 30lbs over this past fall, which prompted my decision to pursue wls. A couple of other things.. I have on and off sinus issues and came down with a nasty sinus infection the day of my eval, so my WBC level was 9.5 (the upper limit of normal). My Vitamin D level was at the very low end of normal. My TIBC level was in the 500's (indicates low Iron levels in your blood). Also, one of my liver enzymes, ALT was 51. My question is, if you had abnormal labs, did you have to wait to have surgery until those levels were normal?

Depends on your insurance requirements, as well as the bariatric program you choose. I just had my initial consult this Friday and found out my insurance does not require PCP clearance, but lots of plans do. Some bariatric programs may still require it even if it's not required by insurance. I also second suggestions to find a new PCP.

It's very good that you were honest and disclosed your history with substances. That said, just like any other evaluation, if you get a result you are not in 100% agreement it is perfectly reasonable to get a second opinion.

Good luck!

Sorry, but if you are going through insurance that likely will not work. Although hiatal hernia repair is often performed with WLS, you still need to complete your pre-op eval, along with whatever your insurance requires (if they even cover bariatric surgery). Some plans require 3-6months of diet supervision, some require none, some have other bizarre exclusions and requirements. You may luck out and have a plan that does not require months of nutrition counseling. That seems to be the most likely thing that prolongs the process. I recommend calling your insurance and finding out what your benefits and requirements are. If it does turn out you need nutrition counseling, well, I've seen many people accept it and make the best of it. You're gonna need those skills post-op, so it's not a complete waste of time. Source: I review bariatric surgeries for a major insurer.