Caribear

For anyone who has Caresource in Ohio, here is their policy as it pertains to Bariatric Surgery as of July 2016: A. SUBJECT Obesity Surgery B. BACKGROUND Surgery for morbid obesity, bariatric surgery, and gastric bypass surgery is a major surgical procedure with significant risk of surgical and post-op complications that should be considered medically necessary only as a treatment alternative when a concerted effort a conventional and conservative management has failed for those who meet the policy criteria below. Prior authorization request for Morbid Obesity Surgery and supporting information must be submitted by the surgeon intending to perform the procedure. Further supporting information may be presented by the PCP or other practitioners, but unless the prior authorization request is submitted by the attending surgeon, the request will be administratively denied for lack of information. C. DEFINITIONS N/A D. POLICY I. The surgery should be considered medically necessary if ALL of the following conditions are met: A. The patient is at least 21 years of age. Members less than 19 years old will be considered only under extreme circumstances. B. The BMI (Body Mass Index) and associated conditions suggest surgery is the most prudent treatment: 1. BMI > 50 with or without associated co-morbidities and failed conservative weight loss attempts as per 3B 2. BMI 40-50 with 1 or more significant co-morbidities not well controlled with appropriate treatment that a surgical weight loss treatment is likely to improve 3. BMI 35-40 with 2 or more co-morbid conditions that are not well controlled with appropriate treatment that a surgical weight loss treatment is likely to improve: a. The co-morbid condition is either poorly controlled on appropriate medical therapy and would likely improve with weight reduction OR by virtue of family history and existing clinical conditions, the patient would remain high risk for short term co-morbid complications without the surgery Examples include Poorly controlled hypertension on multi-drug therapy Inadequately controlled diabetes despite high does insulin treatment and other therapeutic regimens Lipid disorder on maximum drug therapy and lifestyle modification without control C. Written clinical documentation and supporting information from the attending surgeon must include: 1. Letter of medical necessity 2. Evidence that there has been at least a 9 month documented physician supervised trial of diet and exercise within the last 24 months (adapted from NIH recommendations) 3. Summary of co-morbid conditions 4. A description of a multi-disciplinary approach to preparing and managing the patient in the pre-operative and peri-operative periods and through an extended post-operative period 5. Evidence the patient has been evaluated from a psychological standpoint within the past 6 months and which supports that the patient does not have an underlying psychiatric condition which would interfere with the success of the surgery and that the patient will withstand the rigors of the surgery and maintain long-term follow-up care. If the member is under psychiatric care, documentation from their current treating psychiatrist is also required 6. Supporting letter of medical necessity from the patient’s PCP, recommending the surgery and documenting that the patient has undergone medical evaluation to rule out other treatable causes of obesity D. Patients with a history of non-compliance with medical care and any psychiatric illnesses that may hinder compliance with the post-operative regimen are not suitable for surgery. -- Your surgeon may also require additional testing and clearances, but this is what Caresource requires. Hopefully this helps someone.

Oh my goodness! That is absolutely hilarious.

I know a lady who takes those HotHands toe warmers (the kind with the sticky side on it) and sticks one to the outside of her undershirt so that it sits against her lower back. She swears by them, but they might get expensive after a while. Cheaper than moving to Texas, though.

That is fantastic! I am so happy for you!!!

@@kblanc you should get a hold of fitbit customer service, they are fantastic. My friend accidentally washed her fitbit one, and they sent her a new one even though it was her fault. I would go with them for the customer service alone.

I know you can print your logs off of myfitnesspal. I don't have any experience with baritastic so I can't say about that one.

I also use myfitnesspal, it has a pretty comprehensive food database and makes logging pretty easy.

I would mention it to your team if it is really bothering you. I am pre-op and haven't had to deal with this yet, but I would imagine that your diaphragm and abdominal muscles are probably still healing from the surgery. Did you have a hernia repair by any chance? That might lengthen your recovery time.

I am still pre-op, and have never been a runner, but I am pretty active. I teach fitness classes five days a week. I brought this up to my surgical team, and they said that I would be cleared by 6 weeks for any and all activity, barring complications. They also said that they would likely be more aggressive with my diet progression and Protein goals. I know that some of our vets are marathon runners, and they have had some issues getting the appropriate carbs if I remember correctly. Hopefully some of them will come give you some advice. Does your team have an exercise physiologist with whom you can discuss your concerns?

Have you been to a doctor about it? They can usually prescribe some physical therapy that may really help. I would also recommend some good, therapeutic massage therapy, like trigger point or myofascial therapy.

I recommend H2OWear suits for aqua aerobics. Most styles are high-necked so you don't have to worry about any accidental flashing. They come in multiple styles and lots of nice colors and patterns. They are expensive, but I have had my suit for over a year with no fading, sagging, or thinning of the fabric, and I am in the Water usually 5 days a week. They also have a one-year guarantee against chlorine damage. I know you already ordered a suit, but I suggest you check them out. The site is H2Owear(dot)com

@@rolosmom7 If she starts asking questions, tell her you are low-carbing. I would also make sure to go overboard complimenting whatever dish she brings, just to keep her mind off of what you are eating. (I have a few crazies in my family too, can you tell? )

When I went in for my pre op weigh in for approval, I had to remove my shoes and empty my pockets. I haven't heard of anyone having to wear a gown for their weigh in.

I am still pre-op, so take from this what you will, but I would double check with your surgeon about having to wait after drinking to eat. I just saw my dietician and she said that I could drink up until right before I eat, I only have to wait after eating. Another thing to add is that fat tends to store hormones, and since you are losing so fast, you may be having a hormone dump. That will contribute to your feelings of depression and regret. Hang in there, take your anti-nausea meds, and sleep if you need to. You are healing from major surgery and you are allowed to take time to recover. I hope you feel better soon!

@@pensanefloetry I'm so glad to hear you are doing well! I hope your recovery continues to go smoothly. Thanks for keeping us updated!

Good luck, and I hope you have a speedy and smooth recovery! Let us know how it goes. I am really excited for you!

Hi all, I have an appointment next week with my surgeon's group. We will do several clearances all in one day: the psychiatric clearance, nutritionist clearance, and exercise evaluation. I get the first two, but does anyone else know what to expect from the exercise evaluation? It's not cardiopulmonary clearance, but I'm not sure exactly what it is. Anybody else had to do this?

That's interesting. I wonder if my surgeon just has everybody do it just in case. I do not have any issues with lymphedema, and I definitely do not have mobility issues (I teach exercise classes, lol ) Thank you @@KristenLe I am glad to see you recovering well!

I am going to Kettering Bariatrics. I know there are a few of us from the Dayton area. Have you picked a surgeon yet?

If she doesn't want to get it anymore, does that mean she expects you not to get it either? Can you talk to her about how this whole issue is making you feel, or will that make things worse? I'm so sorry that things are this difficult when you are just trying to do something healthy for yourself. I know you love her and I hope you can find a way to work this out. My thoughts and prayers are with you both.

I'm so sorry to hear that, @@pensanefloetry Are you both at the same surgeon's office? It may be very difficult to get things scheduled on the same day. Are you ok with waiting? What happens if she is denied? There are lots of things to consider here. I hope you find a solution that works for everyone.