On Monday afternoon I attended the last group session. It was almost two hours in length, and the person overseeing the session went over nutrition in the days leading up to surgery and nutrition in the days, weeks and first two months after surgery. The importance of multi-vitamins, calcium supplements, vitamin B12 supplements and possibly iron supplements (I’m anemic, so I know I’ll continue to need those) was also stressed. We concluded the session with wishing each other good luck (one woman’s surgery date is November 13th (five days before mine — so envious! Grrr!) and the other woman’s surgery date is December 7th), exchanging email addresses and signing a paper promising to follow up with a group session after surgery.
On my way out from the session I spoke with the receptionist about the whole insurance approval process, and she said that my insurance company wouldn’t receive the pre-auth until Tuesday morning, since the program director had to wait until I completed the last session. When I called Capital BlueCross this afternoon, the woman I spoke with, Kelly, said that the pre-auth had been received, and had been forwarded to the nurse care department for a final review. She assured me that it should be approved with no problem, particularly since I attended a center of excellence and followed their strict requirements. Also, if my pre-auth would be rejected, it would usually be rejected from the offset — not over 24 hours later, when it had been forwarded to whatever department it is that goes over all the jargon outlined in bariatric surgery pre-auth forms and puts the final seal of approval on things. She suggested I call back Friday morning to find out the status, and believe me, I will!
Speaking of phone calls, my surgeon called this evening to let me know that I’ll be the first patient of the day on November 18th — I’ll be taken in for surgery at 9:00am, though I’ll need to arrive around 7:00am for pre-surgery prep. Sounds good to me! I’d hate to come later in the day and possibly have my surgery delayed due to a prior surgery taking longer than expected.
This time next week I’ll be chugging protein shakes for sustenance. My last real meal will be on Tuesday (November 10th) night, and if finances/babysitting arrangements all line up, my husband will be taking me out to Red Lobster for my last supper. I had their crab & shrimp fondue last spring, and it was SO amazing. Seven months later and I’m still thinking about it, so yes, I’m going to enjoy it!
Fourteen days seems like a long time to wait, but I have a lot of home and work things to get in order between now and the evening of November 17th, so I know that time will speed up soon enough!
I called Capital BlueCross to ask if they received the pre-auth request from my surgeon’s office. The woman I spoke with said that so far nothing is showing up in the system, but once they do have it, approval usually takes 72 hours or less. She also assured me that so long as the criteria is met:
- six month nutrition/weight loss program
- program is done at a Center of Excellence
- I have a BMI of 40+, or a BMI of 35-40 with co-morbidities
… I’ll be approved with no problems.
*This is me doing my pre-insurance approval tentative happy dance*
Anyway, I just printed out my food log from the past month, as it will soon be time for me to hit the road if I plan on making it to my last group session! 
The surgical weight loss center called this morning to confirm my appointments for this week:
Today: the last of the three group sessions. I originally was scheduled to attend the last group session on Thursday, but that session is for band patients. Since I am having gastric bypass, I’ll be attending the gastric bypass group session, which is today. It’s at 2:30, and will probably last at least an hour.
Thursday, November 5th at 8:30am: second and last appointment with my surgeon.
Thursday, November 5th at 11:30am: appointment with pre-admissions and anesthesiologist
The woman I spoke with also told me that they submitted the paperwork to my insurance company last week. Once the pre-auth comes back, I’m good to go. To be honest, I’m waiting on that to come through before I go absolutely crazy about having weight loss surgery. In my mind, until the insurance company gives its seal of approval, I’m not 100%, definitely, for sure, absolutely without a doubt having surgery, you know?
Right now my biggest fear is not getting insurance approval for the surgery. Once my surgeon confirms that the insurance will cover the surgery, I’ll be able to breathe a lot easier. When I first started contemplating surgical weight loss two years ago, one of the first things I did is call my health insurance company (Capital BlueCross) and ask if they covered it. They looked up my specific coverage plan (which is provided through my husband’s employer; we pay nearly $500 a month to cover the two of us) and confirmed that yes, surgical weight loss would be covered, provided that I went to a participating provider and met the eligibility requirements. I’d also have to pay a deductible (based upon the entire year, not specific appointments and procedures) and 10% of surgery costs (which I’m guessing will be somewhere in the range of $2000?).
But that was two years ago, and a lot has changed between then and now. Namely, the economy. Also? My husband’s company is cheap, and after reading about many people finding out that their weight loss surgery would not be covered because their employer didn’t pay for it for the company’s health care package, I wondered if that might unfortunately be the case for me. Fortunately, it’s not. Next to me is a thick booklet titled “Certificate of Coverage”, and it’s for 2009. On page 46, under the list of exclusions, is the following (the emphasis is mine:
For treatment of obesity and/or morbid obesity, except for surgical treatment of morbid obesity
Well, that’s a sigh of relief. My plan still covers weight loss surgery, and backs up what a rep told me over the phone and in writing two years ago.
I have chosen a center of excellence for my surgery, which means that they are preferred/recommended/almost always covered by Capital BlueCross. I also more than qualify for surgery, since morbid obesity is a BMI of 40 or greater, and mine is around 47.
Logically I know that my insurance company will approve it. I have done everything as directed by the center of excellence, I have the backing of a surgeon and several nutritionists and dietitians, and they themselves said that Capital BlueCross and other BlueCross subsidiaries rarely give them any trouble. But still, until the approval is official, I am going to be edge, and holding back from fully “preparing” for surgery, since there’s still the uncertainty.
I haven’t updated much since the summer because I have been very busy with life in general. But believe me, I haven’t been neglecting my surgical weight loss journey or general weight loss. As of this morning I have lost 40 lbs. exactly. I got below 300 lbs. for good on September 10th, and I haven’t looked back. For the last several weeks I’ve been holding steady between 294 and 297, and then a few days ago I got down to 292. This morning? 291.6. To say I’m thrilled is an understatement.
I did complete my missed blood work in mid-August, and on August 31st I went back to redo my psychological evaluation. I attended the first group meeting on September 2nd, 2009, where we discussed maintaining healthy eating and working on portion control, and I attended my second group meeting on October 5th, 2009, where we discussed what life would be like after surgery, what to look out for, how to eat, etc. One big thing that stuck with me is that addition to picking low-fat choices, chewing food thoroughly and swallowing bites that are no larger than a dime in circumference, meals should be no more than a cup worth of food, total. That I can stick to, and for many dinner meals lately, have been able to do so easily.
This morning I saw my surgeon. My appointment with her was scheduled three and a half weeks ago, and believe me, I was looking forward to this morning! Anyway, I was weighed, my vitals were taken, and then the surgeon came in and we discussed my options: Realize band or gastric bypass. Up until my first group meeting I was 100% certain on having the lap band. I wavered a bit after that, but was still pretty set on the band. This morning I went in with the intention of choosing the Realize band as my choice of weight loss surgery.
An hour and a half later I changed my mind. According to my surgeon, about thirty percent of patients are requiring re-operations for band slippage, band erosion, stomach ulcers, or problems with esophageal dis-motility. Plus the weight loss results with the band are somewhat unpredictable, and it is easy to cheat if you choose slider foods and eat things that may not be large in portion but are high in calories and fat grams. Gastric bypass, on the other hand, is much more strict, and is the “gold standard” for weight loss surgery because it works. Dumping syndrome sounds pretty brutal, but as my surgeon put it, it’s a good lesson-learner. She also said that most gastric bypass patients can eat most foods, though there may be some foods here and there cause problems. And even then, dumping syndrome isn’t always as horrific as some patients make it out to be. One patient may have chills, hot flashes, sweats, nausea, cramping and diarrhea, while another patient may just have some cramps and a bit of diarrhea.
I am having gastric bypass. As much I would prefer the band because it doesn’t require any changing of my digestive system, I don’t want to deal with fill adjustments, band issues, and the risk of surgery down the line. With gastric bypass, excluding any complications, which I am realistic to know are entirely possible, I have the surgery and then I’m good to go.
Whew. With all of that said, I am very, VERY happy to announce that my surgery date is:
November 18th, 2009
This Monday I will be attending the last of the three group sessions. Originally I would have gone to a session on Thursday, November 5th, but that is for patients who are choosing the band. I am now in the gastric bypass group, so I’ll be attending the bypass meeting on Monday, November 2nd at 2:30pm. I’ll also be meeting with the surgeon a second time (the last time prior to surgery!), and I’ll also meet with the anesthesiologist. With those three appointments out of the way, there’s nothing left to do except maintain my weight and show up on the morning of November 18th, 2009.
Great blog post coming sometime Friday morning or afternoon. I’ve just been very busy lately, but I’ll tell you this: surgery is just WEEKS away! *dances*
What stands between me and surgery? The last three group sessions. I believe there is one this Wednesday (or is it Thursday?), and I’m hoping to get into it.
I also had missed blood work that I had to get done last week. A few crucial labs were missed back when I had my blood drawn in March, but they somehow weren’t noticed as being missing until June.
Finally, I have to get another psychological evaluation completed. I had one done in July of last year, but that is now expired. Grrr. Thankfully, I was able to get an appointment set up for this afternoon. Yay!
Things should be moving very quickly, very soon. I should be having my surgery by the end of October/beginning of November. YAY!
