After a year-long fight, I have a surgery date!
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Sammers48220
Posts: 50 Member
To preface this, my insurance process has been a nightmare.
I started all the way back in March, and was required to do a 6-month long medically supervised weight loss program (pretty standard). But I also heard that my particular insurance company would deny you if you gained any weight during the program. Unfortunately, my BMI is very close to 40 and I only have one comorbidity, so losing too much weight would also trigger a denial. It was a trying 6 months.
My surgeon's office submitted everything after I was finally able to attend my consult in early November. My insurance took 3 weeks to get back to me... and came back with an approval for the surgery as an outpatient procedure. In short, I may be stuck with the hospital bill for my stay and because their decision took so long, my surgeon's schedule was booked for the next two months.
All that being said, though, my date is January 30th and I couldn't be happier that this stressful stage of the process is over. I have two months to get ready for surgery, so I have 6 weeks before I need to start my pre-op diet. Has anyone had any experience with a wait time that long? What are some things you would've done to prepare? Or habits you wish you would've started (or broken) before surgery time?
I started all the way back in March, and was required to do a 6-month long medically supervised weight loss program (pretty standard). But I also heard that my particular insurance company would deny you if you gained any weight during the program. Unfortunately, my BMI is very close to 40 and I only have one comorbidity, so losing too much weight would also trigger a denial. It was a trying 6 months.
My surgeon's office submitted everything after I was finally able to attend my consult in early November. My insurance took 3 weeks to get back to me... and came back with an approval for the surgery as an outpatient procedure. In short, I may be stuck with the hospital bill for my stay and because their decision took so long, my surgeon's schedule was booked for the next two months.
All that being said, though, my date is January 30th and I couldn't be happier that this stressful stage of the process is over. I have two months to get ready for surgery, so I have 6 weeks before I need to start my pre-op diet. Has anyone had any experience with a wait time that long? What are some things you would've done to prepare? Or habits you wish you would've started (or broken) before surgery time?
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My insurance required that I go through my surgeon's program for 6 months before they ever started doing pre-surgery testing, such as the sleep study, stress test, psych evaluation, etc, etc. By the time I started my program till the day I had surgery it was 9 months. I took advantage of having this time and I got myself ready for life after surgery - I started changing my habits from day one. I started exercising, eating better, logging my food, and I got myself mentally prepared for this. I got therapy and started journaling and made sure that I had my relationship with food under control. I think all of the work I did pre-surgery made the whole process so much easier afterward. I recovered really well and I was ready to get started with a new way of living. Best of luck to you :-)0
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I live in Canada and WLS has only been covered by our Provincial Health Care Plan for 2 years. I was on a wait list for 13 months for the orientation. I didn't have my surgery till 11 months after the orientation. I just had my surgery on November 12.
I started really getting serious about the program when I had my first appt. with the clinicians back in February. They told us to track on MFP as well as start doing some stretching exercises. I had 3 check ins with the clinicians over 6 months before being put on the wait list for surgery. I was able to take off 35 lbs. on my own before I started the liquid fast 2 weeks before my surgery.
Tracking on MFP, exercising a few times a week and tracking it and limiting my carbs, and staying connected to this VSG thread are the 4 things that helped me the most. You can learn so much from reading posts here and also posting questions and concerns.
Congratulations on getting a surgery date. It will be here before you know it.
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I think that a longish pre-surgery timeline is a benefit to be able to get your house in order, so to speak. My pre-surgery plan was designed to mimic post-surgery life and get us ready for what was coming post-surgery. 1500 calories, 100g protein, 64 oz water and start exercising. Sounds simple, but it works!
Like Garber, I used the pre-surgery time to lose a ton of weight (I know that part is not relevant to OP) and I was in much better physical shape which I believe really helped the surgery and recovery go very well for me. My advice to everyone in the pre-surgery stages is to hit the program hard and sort out what will be difficult for you while you don't have the surgery complicating things. Get as physical as you are able.
Rob0 -
Congrats on finally getting a surgery date! I have never heard of a VSG being done as an outpatient procedure. I would have a conversation with your surgeon about how that would work and his/her thoughts. It might also be worthwhile to have your dr challenge that decision with your insurance company (they won't even do the leak test until day 2 so I'm not sure how outpatient is even safe). Worst case, post procedure, your Dr could provide your ins company with evidence it was medically necessary for you to spend one night in patient.0
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Good luck and congrats with the surgery. I have spent my pre-op time getting ready for life after surgery. I have done a lot of researched and scanned a lot of message boards to see what concerns and issues other people have had. I have tried to work on my mental issues with food as well. I gave up coffee and anything bubbly. I have tried new protein supplements and got vitamins and supplements that I felt would work well for me. I have done some lower cal days and played with a modified liquid day to prepare for my 2 week pre-op liquid stage. I worked on getting in enough protein and weight lifting. I know I will lose muscle with such a low calorie diet and a temporary decrease in exercise so I wanted to build as much muscle as I could. I stopped drinking while I eat, spacing drinks out 1/2 hour from meals. I have learned to put the fork down in between bites and eat slower. These are all things that I have been gradually working on and hope that this will prepare me to be successful after surgery. I am on day 3 of my pre-op diet and so far it is going great. Best of luck.0
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First, congrats on getting your surgery date. For me, getting the surgery date made it "real." I don't know how your surgeon works, but I could not have done surgery as an outpatient. The morning after surgery I had a swallow test to make sure there was no leak. I would assume you would need that too. If there was a leak they would possibly need to take you back into surgery so it wouldn't make sense to release you prior to that. I think the other comments are correct, see if your doctor can intervene and get you at least one night in the hospital. I used my "prep" time period to practice some of the post-surgery behaviors, such as really chewing your food, eating really slowly, and getting in lots of fluid per day.0
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renovagirl wrote: »Congrats on finally getting a surgery date! I have never heard of a VSG being done as an outpatient procedure. I would have a conversation with your surgeon about how that would work and his/her thoughts. It might also be worthwhile to have your dr challenge that decision with your insurance company (they won't even do the leak test until day 2 so I'm not sure how outpatient is even safe). Worst case, post procedure, your Dr could provide your ins company with evidence it was medically necessary for you to spend one night in patient.
My surgeon actually made it clear that my procedure would be inpatient. His office is currently fighting to get my insurance to approve it that way. Currently, they're saying that as soon as I'm admitted after surgery the hospital can call and get a separate approval code... which seems like a lot of extra work. Worst case scenario, I'm on the hook for the hospital bill for my one-night stay. But I'll be an attorney in 4 months, so I'm not afraid to fight that.
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And thank you everyone else for the tips! I've cut out a lot of things, specifically diet pop (sigh), which has always been my vice. I'm also not drinking with my meals anymore. And I just turned my garage into a gym (my roommate is a personal trainer) so working out has never been easier.
I do, however, really need to work on slowing down my eating. My nutritionist told me about an app on your phone that will time your bites for you. I think it's called eat slower? I might try it while I've got some time.0 -
Sammers48220 wrote: »renovagirl wrote: »Congrats on finally getting a surgery date! I have never heard of a VSG being done as an outpatient procedure. I would have a conversation with your surgeon about how that would work and his/her thoughts. It might also be worthwhile to have your dr challenge that decision with your insurance company (they won't even do the leak test until day 2 so I'm not sure how outpatient is even safe). Worst case, post procedure, your Dr could provide your ins company with evidence it was medically necessary for you to spend one night in patient.
My surgeon actually made it clear that my procedure would be inpatient. His office is currently fighting to get my insurance to approve it that way. Currently, they're saying that as soon as I'm admitted after surgery the hospital can call and get a separate approval code... which seems like a lot of extra work. Worst case scenario, I'm on the hook for the hospital bill for my one-night stay. But I'll be an attorney in 4 months, so I'm not afraid to fight that.
sounds like you've got it covered Sammers
(and g/l on the bar exam!!!)0 -
My surgery was an out patient surgery, went back at 8:00 am and was in my car headed home at 11:30. This included a tiny hiatal hernia repair and he does a leak test while the patient is still sedated. My surgeon is a specialist and has performed over 2000 surgeries. He and his partner have their own surgical center especially equipped for this procedure and and when insurance won't allow outpatient he does the surgery at the Emory hospital across the street from both his office and surgicenter. I have been very lucky, I haven't encountered any problems and I have been eating real foods, no pureed anything, since day seven. I am now 5 weeks out yesterday and am down 24.5 lbs.0
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renovagirl wrote: »Sammers48220 wrote: »renovagirl wrote: »Congrats on finally getting a surgery date! I have never heard of a VSG being done as an outpatient procedure. I would have a conversation with your surgeon about how that would work and his/her thoughts. It might also be worthwhile to have your dr challenge that decision with your insurance company (they won't even do the leak test until day 2 so I'm not sure how outpatient is even safe). Worst case, post procedure, your Dr could provide your ins company with evidence it was medically necessary for you to spend one night in patient.
My surgeon actually made it clear that my procedure would be inpatient. His office is currently fighting to get my insurance to approve it that way. Currently, they're saying that as soon as I'm admitted after surgery the hospital can call and get a separate approval code... which seems like a lot of extra work. Worst case scenario, I'm on the hook for the hospital bill for my one-night stay. But I'll be an attorney in 4 months, so I'm not afraid to fight that.
sounds like you've got it covered Sammers
(and g/l on the bar exam!!!)
Thanks!!!0 -
Congrats! I had to go to classes and weigh-ins for 6 months before my pre-surgery testing. I am glad because it prepared me for what was ahead. My husband was not approved for surgery and he was scheduled to have surgery before me. He has been fighting the ins co for 6 months now. He had gained 4 lbs over the previous year and they turned him down. The ins co told the Dr that they could try again in 90 days if hubby lost more weight. He did. Yesterday they sent us another Unapproved letter stating that the appeal was not done in 60 days after the Dr was told 90! Here we go again0
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Congrats! I had to go to classes and weigh-ins for 6 months before my pre-surgery testing. I am glad because it prepared me for what was ahead. My husband was not approved for surgery and he was scheduled to have surgery before me. He has been fighting the ins co for 6 months now. He had gained 4 lbs over the previous year and they turned him down. The ins co told the Dr that they could try again in 90 days if hubby lost more weight. He did. Yesterday they sent us another Unapproved letter stating that the appeal was not done in 60 days after the Dr was told 90! Here we go again
The law firm I work for is a plaintiff's firm and we deal with insurance companies every day.... this sounds really, really familiar. If you can't get them to work with you soon I would consider hiring an attorney. Even a demand letter on a law firm's letterhead can be enough sometimes.
My advice is to document, document, document everything! Anything they tell you over the phone, get it in writing and make copies. Insurance companies have a nasty habit of doing things just because they think they can get away with it.
Good luck to your husband!0 -
Ty sammers48220! We will follow through
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