Dispelling the myth

[SunyInFla]

Contrary to popular misconceptions, it is not the intent of insurance companies to make your life hell by having to go through certain steps prior to starting your surgical journey. Guidelines for patient selection, course of treatment and nutritional follow up has been well documented by the physician community. Research what the American Society of Bariatric Surgeons suggest for their physician's to follow for patient protocol. Research what teaching hospitals are using for their classes on bariatric surgery. Research what professional medical journals are publishing on bariatric surgery.

Information from all of these sources are drawn from when an insurance company develops their coverage policies. This holds true with any type of medical treatment. They simply do not pull these things out of the thin air. The carriers review these resources periodically to make adjustments in their criteria so that they keep abreast of the standards for the care BY THE MEDICAL COMMUNITY.

That being said, be glad that someone is making you step back, go through pre-surgical diet, exercise and psychological evaluations. These are being done with your best interest at heart. Following these processes just opens the door to making your life long decision to have surgery have a better outcome.

The decision to have WLS should not be made lightly. It is a life-altering procedure. Be glad these "rules of the road" are out there as without them, we may not be having the success rates that we have with the surgeries. Be wary of any practice that doesn't incorporate these into their own practice protocol as a standard for WLS (without insurance requirements) as they may really only have their own wallets in mind and not your health.

Robin

Bariatrics The branch of medicine that deals with the causes, prevention, and treatment of obesity. The term bariatrics was created around 1965, from the Greek root baro ("weight," as in barometer), suffix -iatr ("treatment," as in pediatrics), and suffix -ic ("pertaining to"). Besides the pharmacotherapy of obesity, it is concerned with obesity surgery.

[MsJacquiiC]

Awesome post Robin. Thanks for that.

I tell you what though. I had to jump through major hoops which finally culminated in me having the roux-en-y gastric bypass on April 28th this year. If it had not been for my surgeons office as Center of Excellence stamp of approval amongst other things - I do not think that I would have been prepared for the post-op WLS life. I'm thankful that I've had a nice support system as well - my local support group is awesome - it's nice being amongst a group of people who know and understand the plight of being surgically altered via WLS. Also - my online support system -- which now includes WLS Journey Community Forums -- has been a great help as well. And yes - the insurance approval is sometimes a tedious process, but I do seriously believe that the best interest at mind is for that of the prospective patient like you said in your post.

Again - thanks for that - it's worded wonderfully and I mostly agree with it ==>

Jacquii.

Roux-en-Y Gastric Bypass A type of gastric bypass procedure which combines restrictive and malabsorption techniques - meaning, it reduces the amount of food a patient can comfortably eat (restriction), and also reduces the amount of calories that can be digested in the small intestine (malabsorption). This combination of bariatric methods leads to greater weight loss and the roux-en-y procedure is seen as one of the best ways to treat clinically severe obesity. See WLS Videos for animated surgery technique.

Center of Excellence A Bariatric Surgery Center of Excellence is a bariatric program that has been designated a Bariatric Surgery Center of Excellence (COE) by the Surgical Review Corporation, a nonprofit corporation that: Establishes guidelines for assessing bariatric programs Evaluates bariatric programs to ensure they meet certain standards for recognition as a COE A bariatric program that has been designated a COE has met strict criteria and delivers bariatric care that meets high standards. Read more about Bariatric Surgery Centers of Excellence...

[HappySunshineGirl]

Right on, Robin! I think when I was at the beginning of my road to surgery I thought so much of the entire process was unnecessary and long (over a year for me) but, as the process unfolded, I learned a lot more about it, about others who had it and most of all about myself. It is a serious decision and one I realized that I couldn't just think I was prepared for; I had to know before I did it. I was scared and the surgeon told me he was glad I was because if I wasn't scared he'd be concerned but, he also told me I was making the best decision I would ever make in my life the morning of surgery and I would never regret it.

The insurance company had requirements which I met and some of their required testing alerted me to problems I had no idea I had or that they were so serious. However, aside from the insurance company, as Jacquii just mentioned, the bariatric center of excellence also had quite a few of their own. Looking back, I'm glad that I had to get a psych evaluation, attend counseling, learn about all the things to do and not do and more importantly, what to do if some of them didn't work for me. I'm also glad I was forced to go to a support group meeting before I had the surgery where I heard people talk about the challenges at all different stages and even years out. It's a life saving procedure but it is a serious choice physically and emotionally. It's not for the faint of heart.


Deb

Bariatrics The branch of medicine that deals with the causes, prevention, and treatment of obesity. The term bariatrics was created around 1965, from the Greek root baro ("weight," as in barometer), suffix -iatr ("treatment," as in pediatrics), and suffix -ic ("pertaining to"). Besides the pharmacotherapy of obesity, it is concerned with obesity surgery.

Center of Excellence A Bariatric Surgery Center of Excellence is a bariatric program that has been designated a Bariatric Surgery Center of Excellence (COE) by the Surgical Review Corporation, a nonprofit corporation that: Establishes guidelines for assessing bariatric programs Evaluates bariatric programs to ensure they meet certain standards for recognition as a COE A bariatric program that has been designated a COE has met strict criteria and delivers bariatric care that meets high standards. Read more about Bariatric Surgery Centers of Excellence...

Psychotherapy The testing & treatment of mental and emotional disorders using psychological methods. A psych evaluation is generally required by all Bariatric Surgery Center of Excellence and for most any bariatric surgery insurance approval process.

[MsJacquiiC]

Ha! That should be the universal tagline for WLS Deb: It's not for the faint of heart. And certainly is not an "easy way out" as some would have you believe. I had a lot of issues going into the roux-en-y and still trying to work through the issues that I have... One of them (that I've dealt quite well with the past several months BECAUSE of WLS) was being in large groups or crowds of people. Imagine the panic attack I had at the first "official" WLS seminar I had to attend in order to even schedule my initial surgeon consult -- Definitely not for the faint of heart and certainly not for bi-polar person suffering intermitent panic attacks in groups LOL... Anyway - this process has helped me in more ways than one for sure.

I'm conquering my food addiction. I've attended several support group meetings when I'd never have EVER given a thought to attending such a thing in the past. I'm making a success of the surgery thus far and I'm quite optimistic about longterm. I do know one thing though for sure- and I'll say it anytime someone asks... The 6-month pre-op diet/education classes I had to attend is one of the things that's allowing me the success I've seen thus far. It was mandated by the insurance and I'm glad for it.

Jacquii.

Roux-en-Y Gastric Bypass A type of gastric bypass procedure which combines restrictive and malabsorption techniques - meaning, it reduces the amount of food a patient can comfortably eat (restriction), and also reduces the amount of calories that can be digested in the small intestine (malabsorption). This combination of bariatric methods leads to greater weight loss and the roux-en-y procedure is seen as one of the best ways to treat clinically severe obesity. See WLS Videos for animated surgery technique.

[HappySunshineGirl]

You and I have a lot more in common than you know, Jacquii. And I had problems with my surgery a bit and my eating didn't come right along the way it did for most people. It was a rough road to the point for a year I would not sleep alone without the lights and the tv on. It caused me to have a lot of "emotional" issues beyond the ones I already knew I had that I never expected. Even now, the whole new image thing is great but I'm just now two years later growing into the new me.

Thinking back on it, I'm not sure what I thought leaving the light on was going to do because if it was the surgery itself I was scared of and the adjustment to it then that was a bit silly. If something was going to happen, the RNY aka "Oscar" didn't know the lights were on or off. LOL

My little "Oscar" is still pretty picky about foods we can have even now and as my surgeon said "he is what he is at this point" but those classes and that support made me able to handle it. I was able to learn to cope, to turn the lights off (I bought blackout curtains this summer - a real turnaround for me), to deal with losing my job after fifteen years without totally going nuts at 8 months out because I was an emotional eater and to realize that trying everyday to fight the battle, to know food will always be an addiction and to forgive myself if I make a mistake and get back on track - all came from those classes and that support. And I've proven to myself that the tool works just fine so long as I stay on the course even this far out. If you treat it how it's meant to be treated it will keep your weight where it belongs. The tool helps but it's up to you to keep working at it for the rest of your life and to the follow the rules that got the weight off at the starting line.

Deb

Roux-en-Y Gastric Bypass A type of gastric bypass procedure which combines restrictive and malabsorption techniques - meaning, it reduces the amount of food a patient can comfortably eat (restriction), and also reduces the amount of calories that can be digested in the small intestine (malabsorption). This combination of bariatric methods leads to greater weight loss and the roux-en-y procedure is seen as one of the best ways to treat clinically severe obesity. See WLS Videos for animated surgery technique.