Nutritional Testing

[salsa1877 10]

My PS is sending me for nutritional testing and I was just wondering if anyone else had this? My lap-band doc has NEVER had me have nutritional testing. Is this odd? I eat pretty healthy and take my Vitamins regularly so I am not overly worried, but the battery of tests she is having me take makes my pocket book worry a bit. I am pretty certain I am going to have upwards of 1000$ in lab work/EKG and my insurance WILL NOT cover it! (GULP!):thumbup::):cool2:

[Dr. Schulman 2]

Nutrition testing is important for PS. This will give an indication of how well your body will heal after the procedure. Nutritional deficiencies are much more common after other types of bariatric surgery (gastric bypass, duodenal switch). Testing just requires basic lab tests which are very standard.

I am suprised that you will have to pay out-of-pocket for this bloodwork. Generally, my patient's insurance covers bloodwork (even if it is for a cosmetic procedure). You may have to go to a laboratory that participates with your insurance, or have your primary doctor draw the labs for you.

Another thing you should all be aware of...when the skin is removed, it must be sent to pathology. This is a law (and might vary between states). This allows the pathologists to examine the tissue and make sure there is nothing unusual...and is extremely important with breast surgery. You will likely get another bill from the pathologist and it may be around $100-$200 per specimen. This should also be covered by your insurance as long as the pathologist participates (even for cosmetic surgery).

Again, some of these rules may vary state-to-state, and you should check with your insurance carrier.

[salsa1877 10]

Nutrition testing is important for PS. This will give an indication of how well your body will heal after the procedure. Nutritional deficiencies are much more common after other types of bariatric surgery (gastric bypass, duodenal switch). Testing just requires basic lab tests which are very standard.

I am suprised that you will have to pay out-of-pocket for this bloodwork. Generally, my patient's insurance covers bloodwork (even if it is for a cosmetic procedure). You may have to go to a laboratory that participates with your insurance, or have your primary doctor draw the labs for you.

Another thing you should all be aware of...when the skin is removed, it must be sent to pathology. This is a law (and might vary between states). This allows the pathologists to examine the tissue and make sure there is nothing unusual...and is extremely important with breast surgery. You will likely get another bill from the pathologist and it may be around $100-$200 per specimen. This should also be covered by your insurance as long as the pathologist participates (even for cosmetic surgery).

Again, some of these rules may vary state-to-state, and you should check with your insurance carrier.

Thank you for your response. Nope my insurance will not cover it unless it comes from a PCP and mine refused to order the tests for me because she didn't need to know the answer! I am going to participating provider so they can "bill" insurance, but then at least I can make payments. It is the EKG that I am afraid of for the bill!!

Thanks for informing me about the pathologist bill...didn't expect that one either!

[TexasBecky 1]

Salsa, this is just my opinion, but your pcp sounds like she is working for your insurance company instead of you. Nutritional testing after having lost 100 pounds seems like a totaly legitimate expense to me and an EKG for someone training to run a marathon also seems legit. It is not like you are trying to rip off your insurance company. They did not have to pay for your lap band, yet are reaping the benefits of your improved health and fitness. They are not having to pay for your PS either so a few simple blood tests and and EKG are not unreasonable. I'd call your PCP again and plead your case to get her to order the darn tests. Plus she should care about the results! Good luck.

[StephC 0]

I didnt' have to have any testing done other then the tubes of blood they draw at the pre-op visit at the hospital (when you talk to the anthesist) and we did a little waiting game in the operating room... for my pregnancy test!!! HA! Even tho I was 100% sure they have to have the test within a week of the surgery. They said since I'm in such good health I didnt' need the EKG and I had one pre-band surgery so they didnt' think that was necessary either. I think that maybe you could question them on that, especially if you had one with the band surgery.

[salsa1877 10]

Unfortunately I didn't have one for my band. The EKG is the one I am not going to get out of since my mom died of a heart attack. I don't mind the testing if it increases the odds of me coming out alive...I just wish that she had told me about this earlier. Money is really tight right now!

[Shalee04 7]

WOW, I would think your PCP would want to make sure everythings ok with you before this surgery, Ande as Becky stated above makes sure your tickers all good for your marathon running. I would go and talk to her again and maybe she will change her mind.

[salsa1877 10]

I just think I am going to change PCP! I called her nurse again today just before I went over for the test and she still wouldn't go for it. I think the problem is that when I went in for my annual yesterday it was the first time I had ever seen her. I haven't gone to a doctor outside of my lap-band doc since being banded (and when I went to urgent care for tendonitis in my foot!) and we moved right before I had my lap-band surgery so my former PCP is in Eugene almost 3 hours away. (I loved her!)

At least the lady at the lab place was nice. She said that I wanted to call Dr. Leffel my PCP that she didn't care and maybe the insurance wouldn't notice that she is a plastic surgeon. I guess we can hope!

[Dr. Schulman 2]

Salsa,

Before surgeries I always require that my patients have a complete physical from their primary MD. this ensures taht everything is OK for surgery - and general anesthesia.

Obviously, many of my procedures are "self-pay" and I have never heard of a PCP not submitting it to insurance.

As a plastic surgeon, I also order lab tests on my own. I give the patients a prescription for bloodwork and they have bloodwork (and EKGs) performed at an outside facility that participates with their insurance (such as Quest Diagnostics, etc.) The fact that I (a Plastic Surgeon) am the ordering physician on the tests does not influence insurance coverage. Insurance ocverage is determined by the specific person (or facility) doing the procedure - ie. the lab.

While I can't make recommendations to you, I agree with the previous posters that stated that these tests results are valid...regardless of whether it is for a cosmetic procedure. Speak to your PS and she should be able to order the tests, or at least give you the name of another PCP who will do the appropriate thing.

[salsa1877 10]

I had the tests today and I am not arguing with the validity of the tests. I do believe that I would rather have them before and know if there is anything wrong. My insurance is just so crappy and we need preauthorization for everything. The only thing I have left is the EKG and I think my lap band doc is going to do it for me when I go for my medical clearance. My PS is fine with my lap-band doc giving medical clearance so that was good. My PCP was just a little odd. She just said she didn't have enough information about me to justify ordering any of those tests. I think that was the most frustrating of all.

Thank you for your input. I truly do value what you contribute and I hope I didn't sound like I was questioning the validity of the tests. I was just wondering whether anyone else had them done and when they were notified. I got a message from my PS telling me this at the end of last week and it kind of took me by surprise! I just had no idea it was coming.

[Turler 6]

Hi Salsa,

I had nutritional testing before my LB surgery last month. It was discovered that I was deficient in Protein and Vit D. Both of which were useful to my doctors. I started eating more Protein and although I've been a 'stickler' for staying out of the sun, my doctor actually has asked me to spend a few minutes each day outside whenever possible! I actually feel a little better...as I know you can when you get a little sunshine! I also think it was good for me to know that my protein levels were already low (BEFORE surgery) so I have to be even more diligent about getting enough post op.

I am sorry your insurance won't pay for this. Mine did as it was considered part of my pre-op testing.

Take care and good luck with your PS!

~C

[Shalee04 7]

I had just moved to a new town when I started my lap band journey and I had to find a new PCP. I thought I wouldn't like the one recomended to me as he was a male and I had a female for about 25 years. BUT he has been just awsome.!!! So yep maybe a new PCP is in order for you also. The most important thing is for you to mmake sure all is ok before this surgery!!!

[salsa1877 10]

OMG my PS is the greatest person in the world. She felt so bad for everything that happened that she got another doctor in her old practice to see me TODAY. I got a call right after school from the PS office that said if I could make it within an hour that the new family doctor would fit me in and she would order all the tests and check me out for a medical clearance. This woman was so sweet and her office staff was a dream. I called my insurance and made sure that she was listed as my new PCP and I think it might all work out. We got pre-auth from the insurance and everything!

Thanks for listening to me complain and moan all day. It has been a frustrating couple of days! BTW my EKG came back sparkling clean!

[TexasBecky 1]

Salsa, I'm so glad it all worked out. Your PS sounds great and now, thanks to her, you've got a great new PCP too. Congrats of the sparkling clean EKG.