Why So Different?

[Tammy310 43]

Hey all, I'm just wondering... why does everyone's protocol seem so different. It's all the same surgery so what's up? Example: just to get my insurance approval I had to have 3 nutritionist meetings, 3 support group meetings, 1 psych visit, 1 letter from my doctor to the surgeon stating that I'm a bariatric candidate. THEN they apply for approval to the insurance. This is a process that I understand can take up to 2 weeks. THEN I'll get a date for two weeks in the future during which I will do the liquid diet AND I believe I must have several series of diagnostic tests that will include a clearance from my pulmonogist and a pulmonary function test. Luckily for me I got to skip the required sleep study because I was diagnosed with OSA in 2008 and already have the machine.

I see some people post with no testing or things scheduled and they have their date now. (??!?!)

also, what pre-op tests can I expect? I've seen EGD, Xray, etc.

Another issue I'm seeing is the pre and post-op diet. My doc said 2 weeks pre-op all liquid except one 300 calorie healthy meal per day. and 3 cups leafy greens. I'll probably do it for lunch at work so that people don't ask questions and get in my business. Post-op is in 5 stages and each is a minimum of a week (could be longer depending on my tolerance): clear liquid, full liquid, puree, soft, then regular.

I've read some posts where people are having problems but they are coming out of surgery and going right to the table to eat the same old stuff.

Why is this so confusing (and scary) ????

Input please?

~Tammy

[Ms skinniness 3,003]

All surgeons have different beliefs and procedures that they follow. Who's to say which one is correct or not.

Food is an addiction and some people go into the surgery as a cure for all, but it's not. It is only us that can make the decision in how much and what you put into your mouth. This is really hard to deal with if your not aware of how head hunger affects you. Some and most, require a psychiatric evaluation to assess for complications from a person's mental being. Yes this is confusing but if you trust your doc, then follow his plan and you will be fine. If you have any other questions, please feel free to ask.

[smb 75]

I'm one week into my two week pre-op liquid diet and we are supposed to be doing Protein Drinks, broth, and Water. That's it.

I'm following more along the lines of your pre-op diet, staying between 800-900 calories. I've lost 8 lbs so it's working out.

[Tammy310 43]

Thanks Dorrie. Luckily for me, I've had to give up most of my food addiction to other health issues. I'm hoping that my "head hunger" won't be hard to control. At least (since I've come here) I now know to expect it.

I do trust my doc and the facility and program are a rated as "center for/of excellence" whatever. So, I pray for a positive outcome.

I do appreciate the support from the forum and all of you "big losers."

[Tammy310 43]

I've lost 8 lbs so it's working out.

I asked the surgeon, what if I lose so much weight that my BMI gets better...will the insurance company deny me? He laughed and said they WANT you to lose. The insurance only goes by first office weight. LOL

I'd still love to see double digit loss before.

Good luck to you!

[Raven21 121]

The pre and post op stuff is the surgeon's call.

All the appointments and stuff are usually protocols from insurance companies and they are all different.

[Izuri 428]

Insurance requirements are based on the insurance's policy because they don't want to give out a ton of money for a patient that they do not feel will be able to comply post-op. Different insurance companies have different requirements, and some allow the employer to have some say in it (especially as far as whether bariatric surgery is not covered at all). For some companies they feel the possibility of health benefits (decreased health risks from obesity) outweighs the cost of surgery. For example, my insurance would cover BMI 50+ with no 6 month classes. If I had been under 50 BMI, I would have been required too. It's all weighing cost vs benefit. If we lose weight and do well, they actually save money in the long run too.

Doctors determine which tests you need based on your health. If you have no significant medical health problems or indications of issues, it cuts down on the number of things they feel you are at a high risk for. My cilnic had pre-op assessment days where they have people from outside clinics come in to do testing in their facility. For me this included 2 chest x-rays, EKG, blood work, gallbladder ultrasound, and a health assessment by a nurse. Since they have it all in the same facility I had it all done within about 4 hours. I haven't been to other clinics, but it sounds like many other doctors have you do each test with another office, rather than coordinating with an office in the same facility. I had never had problems with sleep or GERD so they didn't order an endoscopy or sleep study. I think most doctors order a psych eval too, which was the only thing I didn't have done in office.

I have no clue about the diet differences. I assume it's just the doctor's opinion based on their experience and research.

[Tammy310 43]

@ lzuri: I imagine that they'll want some tests from me then. I have a whole host of issues and qualify with a BMI of 37 because I'm so messed up in every other aspect. lol This is probably the only time being sick works in my favor. (how bad is that) hahaha

[alliecat1095 128]

Insurance requirements are based on the insurance's policy because they don't want to give out a ton of money for a patient that they do not feel will be able to comply post-op. Different insurance companies have different requirements' date=' and some allow the employer to have some say in it (especially as far as whether bariatric surgery is not covered at all). For some companies they feel the possibility of health benefits (decreased health risks from obesity) outweighs the cost of surgery. For example, my insurance would cover BMI 50+ with no 6 month classes. If I had been under 50 BMI, I would have been required too. It's all weighing cost vs benefit. If we lose weight and do well, they actually save money in the long run too.

Doctors determine which tests you need based on your health. If you have no significant medical health problems or indications of issues, it cuts down on the number of things they feel you are at a high risk for. My cilnic had pre-op assessment days where they have people from outside clinics come in to do testing in their facility. For me this included 2 chest x-rays, EKG, blood work, gallbladder ultrasound, and a health assessment by a nurse. Since they have it all in the same facility I had it all done within about 4 hours. I haven't been to other clinics, but it sounds like many other doctors have you do each test with another office, rather than coordinating with an office in the same facility. I had never had problems with sleep or GERD so they didn't order an endoscopy or sleep study. I think most doctors order a psych eval too, which was the only thing I didn't have done in office.

I have no clue about the diet differences. I assume it's just the doctor's opinion based on their experience and research.[/quote']

My insurances doesn't cover bariatric surgery. That was put by the employer. It will cover my sleep study. Otherwise I am paying for everything. My pre-op consisted of 2 wks oh high Protein, low fat and low carbs. And this week 4 Protein Shakes and 1 cup of Soup ...

[smb 75]

I asked the surgeon' date=' what if I lose so much weight that my BMI gets better...will the insurance company deny me? He laughed and said they WANT you to lose. The insurance only goes by first office weight. LOL

I'd still love to see double digit loss before.

Good luck to you![/quote']

Thanks! Good luck to you too!!

It's funny (well, not really) -- when they told me in January I should lose 15 lbs before surgery, I was like NO PROBLEM. I've lost (and gained) 15 lbs so many times.

Well, after 7 months I lost basically nothing. It's very humbling.

So here I am cramming for the test trying to lose as much as possible in the last 2 weeks.

[Ms skinniness 3,003]

TLP_VSG: Here is my experience with my referral for wls. Kaiser required that we lose 10% of our weight. I had a low BMI to begin with. Well I didn't lose the recommended amount of weight and I was referred to my bariatric doctor. I got there and because my BMI was under, the surgeon's office told me that I wasn't qualified for the surgery. I was like WTH? The only reason I got the surgery is because i have diabetes. If I would not have been persistent, I wouldn't be here right now sleeved. So I highly recommend checking with your surgeon to verify that.

[Tammy310 43]

@smb: That's funny. Don't cram too much, you want to be healthy enough for the procedure. My surgeon's office told me that they don't REQUIRE pre-surgical weight loss. It's a plus but not required. According to them, once you start the liquid pre-op prep it will happen on its own. Good luck.

@Dorrie: Technically my insurance should just go right through because I work for the facility where my surgery will be done and we are "self-insured." I only need them to pay the doc. According to him they do NOT require a prescribed amount of weight to be lost ahead of time. They only care about shrinking the liver (because it's laparoscopic) and that will happen during the liquid prep.

_________________________________________________________

Thank GOD because I've been trying like heck to lose forever and even since April I've only lost 3lbs. I've counted every calorie, cut out sweets entirely, I'm practicing 3meals a day (which is more than I ever eat). there is NO WAY I could figure out how to lose 24lbs. This process is a complete eye opener, that's for sure.

I am in awe of the many that seem to have gone through like a breeze.