AlwaysCruising

3 minutes ago, Deegirl31 said:

I actually was shocked with the insurance, it’s not through our regular health plan, its like an add-on that my husbands company has. Every procedure they cover is based on The Dr’s recommendation and not insurance guidelines. The only requirement is our deductible has to be met. It’s really a nice benefit.

I was supposed to see Dr. Gorjala but he only sees patients on certain days. I was nervous about Dr. Lytle but ended up completely at ease. A little back story, I did not want the surgery, but all of my local doctors said I needed it. My BMI was only 32 I weighed 188 and am 5’0” and had been on weight watchers after a botched hysterectomy. I had gotten up to 201. I developed a large incisional hernia and no one would fix it until I was down to my ideal weight and weight watchers and gym was not doing it fast enough. My regular insurance would not cover it because my BMI was to low, I was only borderline diabetic, and no cardiac issues or high blood pressure. I was going to file a complaint with the health insurance and our insurance advocate told me about the program. Dr. Lytle reviewed my medical records and had to convince me that my local Drs were right and that I needed to have this surgery to get the hernia fixed. I just met with a local surgeon for the hernia, through the same program and found out how bad things really are, but because I had the surgery I can be fixed. All of my large and small intestines are outside of where they are supposed to be and I have no stomach wall so they need to rebuild it. I will lose my belly button.

I live in Central Florida half way between Daytona and Orlando. My next surgery will be in Orlando at ORMC. Atlanta is huge and I do not miss driving around there. Thankfully we were staying in Sandy Springs around the corner from the hospital. We did travel to Centennial Park when we were there for consult. The traffic is horrible there so I can understand your concern. Lol. I want to wish you luck with everything. It sounds like you have been through a lot yourself. I know everyone at Bariatric Innovations will take great care of you! The trip was well worth it. I wanted Dr. Lytle to fix my hernia also and he agreed to do it, but I needed to consult with a local surgeon first. If it wasn’t so far I would have gone with Dr Lytle but because of the seriousness of the hernia I decided to go with a local surgeon to avoid all the traveling.

Guuuuuurl, that is rough 😞 I love Atlanta, but I would not want to drive from here to there daily (hubby does). Orlando is thick now too, no safe place (she lives in Winter Park for now). Wave at us in a few weeks as we whip through Tampa (long reach, I know LOL). I am so glad that things are getting fixed for you!

Did you ever have a way to contact Star by phone or email directly? Messaging them through that website doesn’t seem to work at all (In fact I almost didn’t use them because I had filled out the paperwork and kept messaging /emailing them and nobody ever responded).

7 hours ago, Deegirl31 said:

I’m rooting for you! Keep me posted, you will do great! 🤗😊

Super interesting on the insurance flying you around! Isn’t it amazing the random differences in health insurance!

I saw Gorjala, apparently my endo (a woman I very much trust) brought him to town (don’t know the back story) and thinks a lot of him. She also likes Lin and the two at John’s Creek (the latter is far too far!). I agree though, overall the requirements are not on the bad side (he doesn’t require a sleep apnea test for everyone which is good and is flexible for those driving in (me me me LOL - it’s a long way across metro Atlanta anywhere near rush hour).

sounds as if I might be near the same diet - my BMI is 35 (well rounded up). I am 5’7” (truthfully 5 7.5) and 222 (although their scale weighed me in boots etc at 236?! so assume they took some off that, still wow!). Because I had so much weight loss before and got a Tummy Tuck, I also have very little stomach (they took 11 lbs of skin during thatm egads). Honestly, I just pray it means they won’t pump a lot of gas is me as during my hysterectomy that was the bad part!

What section of FL? My sister is in Orlando (doc there) but leaving for CO soon, family also in Sarasota and we cruise out of there often (Tampa next).

On 1/11/2017 at 9:46 AM, sleeved_nev said:

I got mine done at Emory midtown 12/12/2016.. very professional but you have to meet certain requirements before you can initially meet with the surgeon... per insurance. Psych evaluation, Registered dietitian. I had open heart surgery last year due to aortic dissection I had to get my annual CT scan and cardiac clearance. 5yrs diet history. Letter of medical necessity from your primary doctor. Your first $300 is refunded if surgery not approved. You only pay the other $300 once approved before final nutrition class. Can not gain any weight once you start the process and you must attend nutrition classes consecutively 4-6 months depending on insurance requirements. Since I work for Emory Healthcare my process was smooth. Check into it due your own research.

Sent from my iPhone using the BariatricPal App

I know this was a few years back, but I really would love to know which are those requirements were insurance ones - I live an hours drive away and each time in is a day off work. The first surgeon that I saw allows me to meet with the dietician 3 visits (2 can be by phone) - wondered if that was Emory or insurance requiring that. 😊

8 minutes ago, JRT Mom said:

Actually, I do have that gene, also! Do you hate liver, also? I've always said there was something in liver that some people could taste and others couldn't. Those that taste it HAAAATE it. Those that can't. love it. No one is ambivalent about liver. Anyway, why would anyone want to eat something whose primary purpose is to filter all the toxins out that animal was exposed to?!?

Strangely I like liver. But unless I make it I wouldn’t have it and well... that isn’t happening! But beer or wine? 🤢🤮🥴 no worries on me being a drunk for sure. I was just relieved to know I was not simply a freak for not looking Water (Splenda changed things in such a good way for me, Equal also, saccharin is horribly bitter and I cannot have it in any food/drink). Remember Tab and Fresca? I would have died of thirst before drinking either one. At least we are freaks together if we are freaks 😂🤗👩🏽‍🤝‍👩🏼

I just am coming off a really bad 2 week cold (yes, many last that long) and no joke, I can’t imagine not being able to breathe through my nose and coughing my head off after surgery. I couldn’t work for a week. A few colds are a week only, but it is just hard to predict the course. Hopefully it will/did work out!

On 2/20/2020 at 9:51 PM, JRT Mom said:

Sounds good! I'm always looking for a good fluids source since I HATE to drink Water.

I always hated Water too. But I was early in on DNA testing (15+ years ago) and have run it through several scientific data bases. I was not surprised to find out I am what they sometimes call a “super taster” - someone who has a gene that results in tasting bitter tastes far more strongly than others. I would bet you have the same gene.

So alcohol? Bleck! Black coffee? Not happening. And I never liked water, it has a slight bitterness. Explained a lot I thought since what covers bitter coffee taste? Sugar and cream and lots of it. I cannot drink water plain so I was delighted she the water enhances (SF) came out. They make all the difference for me!

1 hour ago, momof3_angels said:

LOL... my bariatric Vitamin is way bigger than an M&M! Of course, no way I could have taken it before 4 months post op... but have no trouble with it now (almost 6 months). I take it with 3 very small medications. Immediately post op I could only swallow pills the size of maybe half an M&M.

I keep looking at those huge metformin pills for my PCOS and think boy I hope this surgery helps my insulin resistance because these 3 add up bulk wise to more than a day’s worth of food 😫

P.S. I had to dictate the post above quickly and it clearly failed me 😂🤣 I apologize for it being butchered in terms of spelling, grammar, and black holes - sometimes I think my iPad is plotting against me! 😭

56 minutes ago, Deegirl31 said:

Hi Bezy,

I have extenuating circumstances so there was no medical insurance requirements because it was strictly for medical reasons. The office required the following:
Testing:
EKG, colonoscopy, endoscopy, psych evaluation, support group. They also give you information to watch videos online to understand the procedure and the transition.

Diet:
Depending on your weight at your meeting with the nutritionist, the pre-op diet (for me) was 2 weeks soft, 2 days liquid. Yours will be based on your specific situation, so it may be longer I believe. You MUST BE SMOKE FREE and they will test you, No carbonation and no caffeine. I hope this is the info you needed and it helped. They will give you a packet once you meet with the surgeon and nutritionist.

That was quite a drive for you!

Usually insurance still levies requirements unless in some extremely rare case where it’s done on an emergency basis. But I really am taking about on the surgeon’s requirements 🙂. Do you remember if it specifically said EKG or it just said cardiac clearance? The paper I have says Medical or cardiac clearance but the info itself doesn’t specify particular requirement (as to certain test) on that (since there are many cardiac tests that can be done of different complexities). Do you mind sharing with me how old you were at the time? Thanks!

(PS thank God I stopped smoking more than a decade back - I have two insurance policies but their requirements aren’t bad at all and I already had a sleep apnea and scope set up for my own knowledge so at least not a huge and horrible list)

On 2/27/2020 at 7:14 PM, Deegirl31 said:

Dr. Lytle is an AMAZING Dr!! You will love him and his staff at Bariatric Innovations of Atlanta! He is kind, compassionate and very honest about everything from beginning to end! He is quick with responding to any questions you have at any time. The entire staff is friendly and helpful. They truly saved my life emotionally. I have had no problems at all getting in contact with the nutritionist, or Dr. Lytle for any follow-up care needed over the phone. They will work with your local doctors as well, being that you are out of state. I have NO complications from surgery, he is very careful and thorough. I am 6 months out.

Good luck with your upcoming surgery, you are in excellent hands. I hope this helps.

PS since we will be surgeon sisters, please feel free to reach out to me at any time. I’m very happy for you!

Hi!! Could you tell me what the requirements were that the surgeon asked for (vs. the insurance company)?

My endo recommended Dr, Gorjala. I can also tell you that Dr. Ryland Scott in Rome is extremely nice and Dr. Lin at a Emory (midtown) has a great reputation.

On 2/23/2020 at 5:48 PM, lisafrommassachusetts said:

I hav also frozen Protein Drinks to a slushy consistency. Premier caramel and banana cream were good that way.

Such a great idea!!!

Great info! I have an a lot of people that felt that their taste changed after bariatric surgery. I know one who really could not stand the taste of Water enhancers afterwards. Of course people have such a variety of preferences, but it is nice to get some consensus (saves time and money!).

I am so sorry about Ginger. I have no idea why people don’t realize how much we humans can love an animal and how much they can love us. If you ask me, things with fur make life worthwhile. And how lucky she was to have you ❤️

Unfortunately insurance is as variable as snowflakes. But if you know your insurance basics (like the deductible, percentage paid after deductible, and out of pocket maximum) you can get at least a rough idea of the cost.

Honestly I am very happy that my BMI is 35 and not 40, it’s less distance that I need to go. If it weren’t legit, insurance wouldn’t approve it so maybe that is one way to look at it!

I wouldn’t tell you what to do, but there are a lot of people who had bands in the past having them removed or revised to another type of surgery. It is based solely on restriction (while the sleeve and bypass use restriction but also go further in that other factors such as gastric variables also come into play in assisting with weight loss).

I was told by my nutritionist that I could have carbonated beverages after the sleeve (the only one that I ever drink is diet ginger ale). She said the reason some prohibit it is that some people get stomach pains when drinking soda. I am curious as to which of you react badly to it and which of you tolerate it well? I can live without it, it’s just nice having an alternative to flavored water.

When my endo about jumped off her stool in horror when I mentioned gastric bypass 😟

Not really. That is the truth. Moisture is always good advice but nothing will stop your skin from sagging. Who would be a lot better I think if people could just except that is what it’s going to be and either resign themselves to it or understand they will need surgery. I lost 100 lb by eating super healthy and working out a LOT and I did it slowly (as that is the only way it comes off after 50 when you have PCOS and thyroiditis!) - and I had skin of my stomach, arms and upper thighs that was bad and it was very crepe-like most everywhere else. I decided to do my stomach (11 lbs of skin) and my arms O6 lbs) and as for my thighs I don’t wear pants that show it if at all possible.

this is a before and after of my arms - the plastic surgeon said “well you got all the fat out of there!’ 😂

Here are some basics that I hope will help you -

there are two basic kinds of plans. 1. You have a straight copay ( there may be different amounts for your pcp and specialists) and 2. A deductible and then a percentage (for a few lucky people that is 0, but usually it’s between 10-30%).

When you have a deductible, that means that every year when it turns over, that’s usually in January but for a few companies it can be in the fall, do you have to begin again and meeting your deductible. Remember that you aren’t paying the full price of a provider service but I instead you pay a discounted rate based on your individual insurance carrier (providers contract with each insurance company for a set rate and those usually very across states and whether it’s in a metropolitan or rural area), how much ”usual and customary” price/rate.

You pay the usual and customary rate until you meet your deductible, but once you meet that you only pay a percentage of the rate (this is called co-insurance). Once you meet your out-of-pocket maximum, then you pay zero. But all of that starts over when you get to the turnaround time each year.

An example. Let’s say your deductible is 300 (wouldn’t that be nice, mine is 6,000!) then a 25% co-insurance. Then you visit your doctor and the usual and customary rate for each visit is $100. So, once you go 3 times you will have met your deductible and the 4th visit and those after for the year would only be $25 each.

Don’t worry that you don’t understand all this, lots of people don’t. And there’s no reason you would without a lot of experience with either doctors offices or medical billing. Good luck!

do you mind my asking what your BMI was and any co- morbidities? I just talked to them today and they only list the big ones, without latitude it seemed. The rep actually said to me the fact it was so set suggested they would have to give some... who knows. She recommended having my endo send a request in.

Curious - I am just looking for info at this point. We have two policies, but my BMI is 35 snd I don’t want to have to get a diagnosis of diabetes (currently have PCOS and borderline diabetic and that is bad enough. Not sure if Tricare is less picky about co-morbidities than BCBS of Illinois so despite double coverage I still may have to pay.

I was wondering what the cash charge was for the surgery part alone (I mean minus pre-op workup which my insurance should cover).