[Mab]

Hi, everyone. Hope you all had a fantastic holiday. I have a question about insurance that it seems the insurance company cannot answer for me until the paperwork is submitted.

I am covered by United HealthCare under AT&T's plan. AT&T lists their requirements for surgery:

Surgical treatment of morbid obesity received from a Network or
ONA-PPO Provider is covered. All of the following criteria must be met:
• Covered Person must have a minimum BMI of 40;
• Covered Person must have documentation of a diagnosis of morbid obesity for a minimum of five (5) years from a Physician;
• Covered Person must be 18 years or older; and
• Surgery must be performed at a Network or ONA-PPO Provider by a Network or ONA-PPO surgeon. This is true even if there are no Network or ONA-PPO
Providers near the Covered Person.
• Benefits are limited to one procedure during the entire period of time you are covered under AT&T Medical.

It makes no mention of the much talked about 6 month medically supervised diet. While I have no problem doing that, 6 months from now is when our Summer Reading Program starts (I am a children's librarian) and there is NO WAY I could schedule elective surgery for June or July. (FYI the surgery I am most contemplating is LapBand.)

So does anyone know if there are also qualifications to be met outside of the plan that I'm on that would require me to do the 6 month thing?

Thanks in advance!

[nursesrock]

I would consult the surgeon's office. They can tell you what each insurance co has required in the past for their patients. I know it seems a long way out, but they'll probably suggest you submit to all of those 6 month details, psych eval, supervised nutritionist, etc etc........if you get denied by United, you'll likely lose your chance to do this, as they are famous for denying their patients. Go to your local bariatric surgeon's start up conference and ask their insurance specialists. Also, I'll mention here that a lot of lap banders eventually go for the more invasive surgeries down the road. United won't pay for both, so it's best to investigate all of your options to make the best choice. Good Luck!!

[Mab]

Thanks for your reply! I've been to one of the conferences but I was with a different provider. I may attend another (I think there's one this weekend) to give myself a refresher.

I'm not overly concerned about being denied. My BMI is 42 and I have diabetes. I also have a record of being morbidly obese for five years. I would actually rather wait 6 months to have it done, unfortunately the timing stinks. I will definitely check with the surgeon's insurance person - I'm trying to get a consult for next week.

I was actually dead set on gastric sleeve, but I am very concerned about staying in the hospital for any length of time. I do not react well psychologically to being drugged up and away from home. My instinct for fight or flight sets in. I've been watching some youtube videos on all of the procedures and decided on lap band because it was the least invasive and I would be back at work much sooner.

I would love to hear your experience with having the gastric sleeve done. What made you choose that option? How bad was the pain afterward? How long were you in the hospital? When were you able to get back to work?

Thanks again for your reply.

[nursesrock]

Hi again! I'll tell you what led to my decision- I didn't consider the lap band simply because that's a foreign body inside of you that will eventually need to be revised or removed at some point, as they do break down eventually, Being a medical professional, I was worried about adhesions and all that stuff sticking to my insides- I have nothing to back that up other than I may know too much medical stuff in general. I also didn't want to spend all that time in the MD office fillling, un-filling, etc etc or getting food stuck and having to throw that up. Again, my personal view only.
I could have done the bypass and so many of the folks on this forum have had great success. I was leary of the extent of the surgery and some of the side effects (like dumping). I think those are minor issues for most, and you learn quickly what makes that happen.

I like the sleeve because my digestion and absorption haven't been interrupted. My situation isn't just carbs or sweets, but the over-eating constantly. It's mostly impossible for me to take in the amount of food I would have in the past. The stomach holds about a pound of food- mine holds about 4-6 oz, or 25% of the total. I still have to watch the types of foods I each, as bread makes me feel like I ate a soccer ball, and carbonated/caffeinated drinks are also uncomfortable. So that's another type of restriction of my diet I need. Will that change over time? I have no idea.

I was in the hospital overnight. I had a pain pump (which may not be a great move for you if narcotics make your "fight or flight" issues worse") the day of surgery. The pain was manageable for me, although I did use my pain pills for several weeks after surgery. Again, if chronic pain is an issue for you, that experience may be different. I was re-hospitalized 4 days after surgery for a fluid collection in my abdomen/fever for 2 days. This was unusual, and pretty much sucked. I have had no other issues than those associated with rapid weight loss like hair loss, etc. I was back to work in 4 weeks, mostly because of that 2nd hospitalization and because I had the time at work to do so.

I hope this sheds some light, everyone is different and not all situations and surgeons are the same.