Janecoda

I was finally able to get some clarification regarding my coverage. Knowing what to expect puts me at ease.

Gastric Bypass Surgery (Bariatric Surgery) is covered only if specific medical criteria are met:
 Bariatric surgery may be indicated for patients 18 to 60 years of age. Requests for bariatric surgery for patients less than 18 years of age should include documentation that the primary care physician has addressed the risk of surgery on future growth, the patient's maturity level and the patient’s ability to understand the procedure and comply with postoperative instructions, as well as the adequacy of family support. Patients above 60 years of age may be considered if it is documented in the medical record that the patient’s physiologic age and co-morbid condition(s) result in a positive risk/benefit ratio. • The patient has been clinically evaluated by an MD or DO. The physician has documented failure of non-surgical management including a structured, professionally supervised (physician or non-physician) weight loss program for a minimum of six consecutive months within the last four years prior to the recommendation for bariatric surgery. The six consecutive month weight loss program listed above is waived for super morbidly obese individuals who have a BMI ≥50. Documentation should include periodic weights, dietary therapy and physical exercise, as well as behavioral therapy, counseling and pharmacotherapy, as indicated. • Documentation that the PCP and the patient have a good understanding of the risks involved and reasonable expectations that the patient will be compliant with all postsurgical requirements. • A psychological evaluation must be performed as a pre-surgical assessment by a contracted mental health professional in order to establish the patient’s emotional stability, ability to comprehend the risk of surgery and to give informed consent, and ability to cope with expected post-surgical lifestyle changes and limitations. Such psychological consultations may include one unit total of psychological testing for purposes of personality assessment (e.g., the MMPI-2 or adolescent version, the MMPI-A). • The physician needs to be aware and follow-up with individuals who have had gastric surgery for any long-term complications. • In cases where a revision of the original procedure is planned, documentation of all of the following is required: - Date and type of previous procedure - The factor(s) that precipitated failure - Any complications from the previous procedure that mandate (necessitate) the takedown - If the indication for the revision is a failure of the patient to lose a desired amount of 51 weight then the patient must meet all of the initial preoperative criteria. Note: The following surgical procedures are considered experimental/investigational because their safety and/or effectiveness have not been proven: • Loop gastric bypass gastroplasty - also known as mini-gastric bypass • Stomach stapling Endoscopic procedures to treat weight gain after bariatric surgery to remedy large gastric stoma or large gastric pouches are considered experimental/investigational.

I needed every minute of the 6 month diet to do the work of understanding my eating habits and what I was in for....and I still could have used more time to prepare. I understand being excited and impatient to move forward...but the six month diet is important. Without learning to control your eating habits, you're going to be in trouble.
This surgery is a tool, and it's a tool that fails...a lot...when people are not prepared for the lifetime changes they need to make.
And I don't mean just adjusting to your new anatomy...that's relatively easy. What I mean is...the fact that you will STILL have to count calories, record everything you eat, fight temptation and cravings, and especially... find other outlets for emotional eating, identify your triggers, cope with the things that drove you to eat.
Most of the people who make noise on the boards fall into two catagories. The people who have experienced some degree of success working very very hard. And the people who have experienced some degree of success by the good fortune of an excellent physiological reaction to the surgery regardless of their habits (luck).
Who we DON'T tend to hear from, or see posts from....are the majority of people who have these surgeries.... who never lose more than 50% of their excess weight. When people get unhappy or feel unsuccessful...they don't post about it. Half of people who have this surgery will fall in this category.
You can eat around an altered stomach and gain it all back. It's not even hard to do. The surgery changes one anatomical element to give you an advantage....not a fix. Your head is the place that needs the real fix.
Six months...is a great investment in working to fix your head before you have to deal with your new digestive system.
Are bariatric surgeries a terrific tool? Yes. The new anatomy helps a lot. Another terrific tool...one that is arguably just as helpful and arguably more important to your longterm success......a bariatric therapist.
Make sure you have access to one.
Best wishes to all!

it's usually the insurance company that requires the six-month supervised diet rather than the bariatric clinic - or at least that seems to be the case most of the time. People who don't have insurance coverage and self pay don't usually have to do it. Most surgeons do require some kind of pre-surgery diet, but that's usually just a week or two before the surgery (it's usually clear liquids and protein shakes - or some surgeons do allow you to have one meal a day - like a Lean Cuisine or meat & non-starchy veggies. It varies. Mine, unfortunately, wanted two weeks of liquids only, including protein shakes. That seems to be the most common). But that six-month thing is more often a requirement of the insurance company. They want to see if you're capable of following a program long-term, I think...