Lap Band and Methadone Clinic

[Mommyfrid 12]

Does anybody take methadone and has been approved for the lap band surgery or has already had the surgery?

My surgeon has known that I was on methadone since my first visit. My insurance has already approved me and now I'm jumping thru all the hoops that they require. Testing, etc. I went today for my psychological evaluation and when I revealed I was on methadone because after years of drs writing me pain medication I got addicted. First of all she immediately started treating me differently, but besides that she told me that is a opiate dependency is a psychological disorder and she had to disclose that on my evaluation that would be submitted to the insurance company. She told me the insurance company may not give me the final approval until I'm weaned off it. I immediately called the surgeons office when I left her office and they said she had no right to tell me that because it's not her call, it's the surgeons decision. I'm wondering what the insurance company is specifically looking for in this psychological evaluation. Nobody has a perfect life. I am currently also taking Wellbutrin for situational depression after I lost my job. So I'm worried now. I've spent all this Money to have tests done and see the surgeon and I still have my upper GI to do and an ultrasound on my abdominal area and id hate to spend money out of pocket if the insurance won't give the final approval to schedule the surgery simply bc I made the decision to put myself in treatment so I could improve my quality of life and get off of pain meds. It's not like I have a drug problem that I'm not addressing

Anyway, has anyone encountered a situation like mine or had the surgery while in a methadone clinic? Also, my questions regarding the psych eval too.

Sorry for typing so much I just left her office so upset after working so hard to get this stuff done so I can get my surgery scheduled.

Thanks - Kris

[Stevehud 1,790]

I have a semi unique perspective. My older sister who is an RN worked for years doing pre-approvals for surgeries like this including WLS. I asked her about your situation and she basically told me the surgeon actually has very little say in the insurance approval process, some companies would indeed deny you out of hand and then make you file an appeal so that they can get more information. Others may ask for more information or medical records regarding your treatment, and they may have to have a treatment plan in place that shows how the surgeon and follow up team will deal with your issues. You are lucky in that a lot of surgeons wouldn't even touch you, also there is the fact that meds, do not absorb as easily or for the same amount of time after a sleeve or bypass. So you medication wont work the same. She also said that for example the last insurance company she worked for I cant mention the name but its a huge one, wont ever certify the surgery without you being off the methadone. So its still very up in the air and up to the insurance company. I hope that helps a little.

[Mommyfrid 12]

So Steve...based on your response, which I greatly appreciate, my only comment is that my insurance already approved me. Did I leave that part out? When I initially saw the surgeon I had to disclose any medications that I was taking. So when they submitted my info to the insurance company, I'm assuming it included my medications. Once completing the stuff they asked me to do it gets resubmitted for the final approval. So I'm thinking when they initially relieved my info that if the methadone was an issue I wouldn't have been approved at all. They would've come back and said I had to get off of it first, wouldn't you think? Just curious bc it would be very frustrating for them to put me thru all these tests to come back and say, oh yeah we forgot to mention you have to get off that first, right? Thoughts?

[Stevehud 1,790]

dont get me wrong im not saying you wont be covered Im praying you will. Ok here's from the mouth of one who knows. "most pre-certifications are just qualifiers to see if you even qualify for coverage". That I can attest to as it is with me, i'm covered but now i have to be truly certified. Anyway, when the nurses who do the pre-certification get your report they will question the psych eval and then everything else opens up. So your first approval is proof of coverage, but the final pre-cert is the go ahead for payment, they are drastically different.

[Stevehud 1,790]

and i have to confess i read your post wrong. lap band is different. i for some reason assumed you were having a sleeve or bypass, lap band doesn't have issues with absorption of liquids per se. so skip that part of what i said earlier.

[Mommyfrid 12]

So want to give me a hint on the company who will not approve you until you're off methadone? What if you just gave me the first letter? Lol. Come on help a girl out here. Or how about I give you the first letter of mine (which is A) and you say hot or cold. Lol.

[kikicoates78 220]

Your Insurance hasn't given the final approval if your psych eval hasn't made it to them yet. They may have given information to your surgeons office that the surgery is actually covered by them, but all of your testing records and reports have to be submitted to Insurance for final approval which any WLS goes before a medical board. Even my insurance co. I don't need pre approval for anything. I still had to get all the info to them. They couldn't deny me. But they still needed all the paper work.

[Stevehud 1,790]

very cold. not even close

[Mommyfrid 12]

Lol. Thanks for easing my mind and for all the information. I'll update you when I find out more info.

[meggs353 118]

Good luck! And good for you taking control of your health.

[Miss Mac 6,262]

Wellbutrin did not influence my approval. As a matter of fact, my primary physician had me on Sertraline for post-stroke anxiety, and the bariatrician swtched me to a Wellbutrin generic Bupropion and then before surgery doubled the dose.

I am not well-versed in the advantages or controversies of methadone, but I can tell you something I did that may have helped with my approval. I submitted a heartfelt letter about how obesity runs in my family and has had a negative impact on my quality of life. I mentioned all of my co-morbidities (I will attached a list) and how each of those have affected me. At the end of the letter I thanked the insurance company for the pre-approval and let them know that I am looking forward to the changes in my health and happiness.

Just be as honest as you can, and fess up to the methadone treatment, emphasizing what your plan of action is for weaning of that medication. I don't know if the letter heled, but it didn't hurt. After my final packet was submitted, I was approved in two days. My insurance is BCBS Federal Employee, and the coverage was outstanding. Here is the list of co-morbidities from the National Institute of Health, a government agency. www.NIH.gov

Obesity Comorbidities

To follow is a list of comorbidities (additional conditions or diseases) related to obesity which may help you in qualifying for weight loss surgery.

• Family history of heart disease

• Family history of stroke

• Family history of diabetes

• Family history of heart attacks

• Hyperinsulinemia

• Diabetes

• High blood pressure

• Coronary-artery disease

• Hypertension

• Migraines or headaches directly related to obesity or cranial hypertension

• Congestive heart failure

• Neoplasia

• Dyslipidemia

• Anemia

• Gallbladder disease

• Osteoarthritis

• Degenerative arthritis

• Degenerative disc

• Degenerative joint disease

• Recommended joint replacement from specialist

• Accelerated degenerative joint disease

• Asthma

• Repeated pneumonia

• Repeated pleurisy

• Repeated bronchitis

• Lung restriction

• Gastroesophageal reflex (GERD)

• Excess facial & body hair (Hirsutism)

• Rashes

• Chronic skin infections

• Excess sweating

• Frequent yeast infections

• Urinary stress incontinence

• Menstrual irregularity

• Hormonal abnormalities

• Polycystic ovaries

• Infertility

• Carcinoma (breast, colon, uterine cancer)

• sleep apnea

• Pseudotumor cerebri

• Depression

• Psychological/sexual dysfunction

• Social discrimination

• Premature death in the immediate family

[Mommyfrid 12]

Thank you all for commenting on my concerns. I'm looking forward to finding out next month once my packet is submitted for the final approval. It's an extremely frustrating list of stuff that has to be scheduled and done. I'm jumping thru all of the hoops and I'll update this forum once I have my final answer just in case anyone else is wondering about methadone and just don't want to ask. I'm not embarrassed of my treatment bc I'm in a much better place than I used to be. It's just a shame that people who don't understand addiction/methadone treatment are so rude to people like me. Including that pos psychiatrist today. She was being so nice until I told her that.

[WL WARRIOR 692]

If you had diabetes, should you stop taking your insulin? No. Well, the same goes with your methadone. How dare a psychiatrist tell you something like that. I hate it when a health professional has bias against past addicts. Addiction is a disease even though many people don't see it that way. There will always be ignorant people. There are only two things about Methadone that may complicate this weight surgery process:

1. It is going to be near impossible to find a non-narcotic to help relieve your pain right out of surgery. Maybe the Methadone will be enough to help that pain, but I would definitely bring this up with your doctor so you have a plan. Plus, taking a weeks worth of oxycodone (or other narcotic) after surgery could lead to a relapse. They may want you to stop taking the methadone three days before surgery, take the narcotics right after surgery, and then return to your methadone a week later.

2. Past addicts have a high chance of relapsing after surgery. Your tolerance changes after surgery and there is a chance of reoccurring depression. Those two factors lead some past addicts to relapse.

Here is the most important thing to remember:

You are not a statistic. Stay strong and keep taking your methadone (if you feel like you need it) to help you persevere through the pre op and post op stages. It is stressful and you want to stay on track. That is what your methadone is suppose to help you do right? Is there a support group you can attend for people on Methadone? I know there is NA, but they look down on those that take Methadone and Suboxone. By the way, I have been on Suboxone for 11 years and have not relapsed the whole time. It never interfered with my pre op process. I couldn't tolerate any narcotic pain medication post op. They didn't work and the pain subsided by day 5 after surgery.

One last suggestion, you could get your addiction counselor or doctor to write a letter if you think it might help. I wish you luck!