• American Bariatrics is a free online Bariatric Support Group. Register for your free account and get access to all of our great features!

Hi! :) ...and a couple of questions

Devin

Devin

Member
I've been lurking for a bit...I didn't want to post until I had my consultation since I have both MS and polycystic kidney disease and wasn't sure that bariatric surgery would actually be an option for me. My consultation was yesterday and it is! YAY!
I have a couple of questions if anyone wouldn't mind giving their opinions...
1.) I'm pretty sure that I want the sleeve, but my surgeon said they do 75% bypass and 25% sleeve, it seemed as though he wanted me to consider having bypass instead but said that I would be a great candidate for either...any thoughts on why he seemed to favor bypass?
2.) I have both Anthem Blue Cross Blue Shield which covers 100% of everything with no prior requirements except the BMI...and Medicare which covers 80% with the requirement of 3 months of structured diet visits...do I have to do those 3 months since Anthem is my primary insurance and is going to cover everything anyway?
 
Hello and welcome.
According to statistics people loose more weight with bypass. I don't know how much weight you need/want to loose so maybe that plays a role? I would have asked. I went into my apt. wanting the sleeve and my surgeon expressed concerns about GERD because I already have SEVERE GERD and the sleeve tends to make it worse, or even cause it when people prior to surgery did not have a problem with it.
As far as the insurance, which is your primary? If you primary is blue cross, i would confirm with them and then i would think you would just give the billing dept that ins. card for billing. If medicare is primary, you would likely have to meet their requirements.
 
Welcome to the group Devon. In addition to what Kcuster said, one thing you might want to question your doctors if you are on medications for the MS and polycystic kidney disease is any possible problems with malabsorption.

On the insurance question, your bariatric office would be best to answer that. Talk to the person who deals with the insurance. Most likely they already know what to watch for with different plans as far as requirements go.

Good luck on your journey!
 
Thanks for your replies! Since I have MS I stressed the need to him that I'll likely have to have oral steroids for relapses, he didn't seemed too bothered by the idea of taking them with either option although he said that it could cause ulcers with the bypass. I'm not interested in ulcers, so I think I'll just stick with the sleeve. I weigh 235, I'd be thrilled if I could get down to 150-160. He was fine with either surgery, but he said that bypass has been around longer and has been proven to work long-term whereas the sleeve is newer and that information isn't available yet.
I'll be talking to my surgery coordinator today, but she called a few days ago and told me that Anthem doesn't cover bariatric surgery, which I knew was absolutely not true because I called them personally before I scheduled. She was pretty rude and argued with me until I finally asked her to call them, which she did and then called me back to say that I was right...but was STILL rude about it ....which was irritating since we pay a ton of money to have the highest level of insurance possible. The coordinator and I haven't gotten off to a great start, but I'm going to ask her about it extra nicely today and just kill her with kindness, I guess. Either way 3 months isn't long to wait. I really like this surgeon, so I'll put up with it.
 
That sucks the surgeon has a rude team or coordinator. I have been lucky, every single person on my team so so sweet and attentive. From the surgeon right down to the front desk personnel. Hopefully the rest of the team is easier to work with.
As far as the malabsorption, they have injections for most steriods, you can do at home. I also know, a lot of MS meds come in shot form also. Just an option!
Sounds like the sleeve would be fine, but again. Address all of your concerns with your surgeon and weigh all the pros and cons of both. This way, you can make an informed decision.
 
I did a lot of reading online and it seems like the success rate with RNY bypass is much higher than the sleeve procedure. I also read quite a few stories of sleeve patients having to get “revision surgery” which means converting the sleeve to RNY bypass because the sleeve was not working. I want to get it right the first time, so I’m going to get RNY bypass surgery.
 
suzannethemom said:
I did a lot of reading online and it seems like the success rate with RNY bypass is much higher than the sleeve procedure. I also read quite a few stories of sleeve patients having to get “revision surgery” which means converting the sleeve to RNY bypass because the sleeve was not working. I want to get it right the first time, so I’m going to get RNY bypass surgery.
Click to expand...
I'm sure that you're right about that. I told him I would do more research about it and I will, but I'm 95% sure that I'll probably just stick with the sleeve. At 43, I feel like I've had some kinda odd health issues in addition MS and PKD...I've had brain surgery, gallbladder removal, surgery to remove an ovarian teratoma (which is a disgusting cyst thing that has bone, hair, and sometimes teeth growing in it ) borderline ovarian cancer, a complete hysterectomy, and there's a suspicious cyst on my right kidney that they are watching. I feel like I should probably just do the least invasive in and out type of surgery I can. At this point, it wouldn't be a huge surprise if he cut into my intestine some weird alien space creature jumped out, LOL...just kidding...well mostly...that teratoma thing really freaked me out!
 
Hi Devin welcome to the group!

From my experience - different WLS clinics have different criteria for the different surgeries.

Because of some of my medical issues the duodenal switch would have worked best for my issues. But I didn’t meet the weight requirements.

The sleeve wouldn’t address all of my medical issues. I already had reflux and going with the sleeve had the potential to make it worse.

The best option for me was the bypass. It eliminated me having to take insulin and other diabetic medications, cholesterol meds, and pretty much most of my other medications. My surgical team was hoping it would eliminate my reflux - but that’s one thing it didn’t do.

Talk to your surgical team. Ask questions, show them information you have read about WLS. They should address your issues with a smile and more information. If the team is a group of asses be a bigger ass. If they can’t or won’t address your question in a polite professional manner - you truly may have to show your ass and find a better surgical team.

All questions, comments, concerns should be addressed. There is no such thing as a “stupid” or “unnecessary” questions - but there are so surgeons that don’t like questions. Be your own advocate - don’t let them dismiss your questions or concerns! You got this!!
 
The insurance questions can easily be addressed by the companies who offer them. I'm more concerned that someone is in a position of power, yet seems to be treating you like you don't deserve to know what's going on.

"May I please talk to your supervisor?"

Those six words are more powerful than any weapon. Insist on a super, and if you don't get an answer, keep kicking it up the line until you get to the person you need.

Better still, spare yourself aggravation by asking to speak to the ombudsman. Most hospitals have them. Their only job is to lessen stress and difficulty. An ombudsman can ask your question with power.

I went to an ombudsman when doctors were passing my brother around like he was a hot potato. The result saved his life.

People are paid to serve you, not to treat you like you don't matter. Nothing is more powerful than the threat of involving a higher-up

If you've already reached the top, casually ask for directions to the legal office. Make eye contact. But step back because you don't wanna get messy when they lose their shit on you.

YOU'RE THE BOSS HERE.
 
dianeseattle said:
The insurance questions can easily be addressed by the companies who offer them. I'm more concerned that someone is in a position of power, yet seems to be treating you like you don't deserve to know what's going on.

"May I please talk to your supervisor?"

Those six words are more powerful than any weapon. Insist on a super, and if you don't get an answer, keep kicking it up the line until you get to the person you need.

Better still, spare yourself aggravation by asking to speak to the ombudsman. Most hospitals have them. Their only job is to lessen stress and difficulty. An ombudsman can ask your question with power.

I went to an ombudsman when doctors were passing my brother around like he was a hot potato. The result saved his life.

People are paid to serve you, not to treat you like you don't matter. Nothing is more powerful than the threat of involving a higher-up

If you've already reached the top, casually ask for directions to the legal office. Make eye contact. But step back because you don't wanna get messy when they lose their shit on you.

YOU'RE THE BOSS HERE.
Click to expand...
Thank you! Great advice!❤
 
Devin said:
2.) I have both Anthem Blue Cross Blue Shield which covers 100% of everything with no prior requirements except the BMI...and Medicare which covers 80% with the requirement of 3 months of structured diet visits...do I have to do those 3 months since Anthem is my primary insurance and is going to cover everything anyway?
Click to expand...

I am very grateful you posted this. I have anthem and I chatted with someone who told me the surgery would be fully covered but would not tell me the criteria and all that I could find was stuff from 2020 and I didn’t know how out of date that was. I was worried they would want me to do a medically monitored diet. It’s not losing I can’t do, it’s keeping it off.
 
Just as an aside, I have a Medicare Advantage plan through United Healthcare and I have no pre-qualifications, not even supervised weight loss. Just BMI and I can have whichever surgery I choose. My surgeon however requires the weight loss and 3 visits with a nutritionist. Wondering if the surgeon is requiring vs. the insurance. Anyway, regardless of anything 3 months is a pretty short window of time before surgery. My mom had to go through a years worth of stuff before she had her bypass. Best of luck to you and don’t let anyone push you around! Blessings to you and I hope it goes fast
 
MANDY2910 said:
Just as an aside, I have a Medicare Advantage plan through United Healthcare and I have no pre-qualifications, not even supervised weight loss. Just BMI and I can have whichever surgery I choose. My surgeon however requires the weight loss and 3 visits with a nutritionist. Wondering if the surgeon is requiring vs. the insurance. Anyway, regardless of anything 3 months is a pretty short window of time before surgery. My mom had to go through a years worth of stuff before she had her bypass. Best of luck to you and don’t let anyone push you around! Blessings to you and I hope it goes fast
Click to expand...
Tell me.about it! 3 months really is short. By the time I have my surgery it will be 11 months haha
 
MANDY2910 said:
Just as an aside, I have a Medicare Advantage plan through United Healthcare and I have no pre-qualifications, not even supervised weight loss. Just BMI and I can have whichever surgery I choose. My surgeon however requires the weight loss and 3 visits with a nutritionist. Wondering if the surgeon is requiring vs. the insurance. Anyway, regardless of anything 3 months is a pretty short window of time before surgery. My mom had to go through a years worth of stuff before she had her bypass. Best of luck to you and don’t let anyone push you around! Blessings to you and I hope it goes fast
Click to expand...
I’ve seen the paperwork process for my weight loss center and there’s no diet requirement - thank goodness. You do have to see a nutritionist and the other doctors but I’m hopeful to get in and get moving forward. I’ve never felt more ready for something in my life!!
 
You must log in or register to reply here.
Back
Top