Starting My 6 Months! - Page 4 - ThinnerTimes - Gastric Bypass Forum, Lap Band Forum, and Vertical Sleeve Gastrectomy Forum

Sparkles · 02-26-2009, 03:24 PM

Quote:

Originally Posted by JustJoy

Hi all! I started my six month diet last month and I go see the NUT tomorrow for my first follow-up. They call it the "bubble" diet, you get a sheet with a certain number of "bubbles" to fill in for each category and these "bubbles" add up to a certain caloric intake. Mine is 1300. Some days are easy, other days aren't. Today was a rough day, my stomach was growling and I felt ill because I felt so hungry.

I'm supposed to be quitting soda but I'm putting it off one last week. I'm supposed to be exercising too but I've been sick off and on so it's been hard to feel like exercising much less doing it.

I'm using this time to learn my new eating habits for after surgery, no drinking 30 min before, during, or 30-45 min after meals. This is a lot easier than I thought it would be now that I'm a month into it. It was kind of funny, one night my husband brought me a soda to have with my meal and I looked at him like he'd lost his mind and said "I can't have that." It had slipped his mind that I didn't drink with meals anymore.

I'm concerned, as someone else mentioned, about losing too much weight and not qualifying with my insurance. I'm trying to be careful about how much I lose. So far I think I've lost around four or five pounds. I'll find out tomorrow for sure.

Joy

OoOo Joy sounds like an interesting little diet. Hmmm looks like its working. Let us know how your NUT visit goes. I am sure you will be fine.

Tess · 02-26-2009, 08:07 PM

yeah that was me. I'm at 42 BMI now if I lose 30 lbs I'll be well below. I bet anything you gotta gain it back. Its stupid

I see my surgeon tomorrow. I'll find out then

Ms. Readytobehealthy · 02-27-2009, 06:34 AM

The tips I am talking about is what the nurse needs to write on my diet visit paperwork. I am actually faxing over the information to the surgeoon once a month so they will know if the notes are good enough. So that is going to help me out. I hate to wait until the end of my 6 months and they tell me this not enough documentation. I am getting all my stuff in order so nothing can hold me back when it is time for surgery. I am very determined.

JustJoy · 02-27-2009, 07:16 AM

Quote:

Originally Posted by Ms. Readytobehealthy

The tips I am talking about is what the nurse needs to write on my diet visit paperwork. I am actually faxing over the information to the surgeoon once a month so they will know if the notes are good enough. So that is going to help me out. I hate to wait until the end of my 6 months and they tell me this not enough documentation. I am getting all my stuff in order so nothing can hold me back when it is time for surgery. I am very determined.

It pays to be proactive and have those ducks in nice neat rows. Insurance companies have lots of little loopholes that are annoying as heck. This is why I decided to do my diet follow-ups with the bariatric center (2 hrs one way) rather than in town with my PCD, I don't want to take *any* chances for the documentation to be lacking and have to start over.

Joy

Tess · 02-27-2009, 07:33 AM

Quote:

Originally Posted by JustJoy

It pays to be proactive and have those ducks in nice neat rows. Insurance companies have lots of little loopholes that are annoying as heck. This is why I decided to do my diet follow-ups with the bariatric center (2 hrs one way) rather than in town with my PCD, I don't want to take *any* chances for the documentation to be lacking and have to start over.

Joy

Yeah me too. I'm to afraid I'll get to the end and they will say "sorry we need more information". lol. I'm 1.1/2 hour each way, its only once a month. Plus I just feel good checking in and being able to ask any questions I may need to ask. Lord knows I'll have tons before the big day. I also know of many people who have done it all right and still been turned down. I wont commit to a surgery day until I get the date from the surgeons office. I'm hoping for the end of the summer but who know. I may have to put all this weight back on first. lol.
I'm off to the Surgeon now, I'm interested to find out how all this works, the losing to much weight.
Id really like to hear from someone who has already been there and how it worked out for them. Anyone go well below your BMI at the end of your 6 months?

Band_Groupie · 02-27-2009, 08:00 AM

I think I read all the posts here, so I'll tell you what I've learned (I go for my 5th PCP visit on Monday). I messed myself up at the beginning not knowing all of this and lost two months that I had to begin again. This is probably way more info. than you need, but if it helps someone...
- If you haven't already, call your ins. co. and get a copy of your bariatric policy so you know their rules. Most can show you how to download it online even, or they can send it to you (you have a right to a copy).

The rest of these apply to my case and what I've seen from others, but your ins. may be different:
- Personally, I've found the insurance person at my surgeon's office to be the best source of information since she deals with my ins. co. all the time. Call that person with a list of your questions...ie. your ins. co. will never tell you or spell out in their policy that they expect you not to lose below the minimum BMI, and the ins. expert at your surgeon's office can't legally tell you that either, so word your questions carefully and listen to what they DO say...mine said "If you fall below the minimum 35 BMI then you wouldn't need the surgery would you?" I let her know I got it and she was visably relieved (I've seen lots of posts where people don't get it).
- Make sure you're well over the min. BMI you need (35 or 40) at your first weigh in (I learned this the hard way and had to start over...was 1 pound below). Eat a big meal, wear heavy layered clothing, drink water until you're ready to burst, wear your cell phone and put your wallet in your pocket (like men do).
- Get a seperate form from you surgeon to use at the PCP visits. The surgeon should have a sample to use, if not let me know. You'll turn all these seperate forms into the surgeon along with the PCP letter of 'medical necessity'. I have my PCP keep a copy and I take the original and fax it to my surgeon's office. Not keeping this on a seperate form is risky as the regular 'Doctors notes' that they keep in your file may not be enough or they might forget to note something as simple as your weight that mo. I've seen people denied for their Dr's. notes being incomplete even one mo.
- The monthly visits also have to include doctors notes on EXERCISE program. This gets a lot of people denied. Just have them make a note on what they've asked you to do (ie. 30 min 4x a week) and how well you did with exercise last mo.
- Make sure you know if you are allowed to fall below the minimum (35 or 40) BMI during your 6 mo. (see second bullet point above). None of the three hospitals I intitially looked at wanted you to lose more than a few 5-10 pounds and not go below your min. BMI. I can only lose 10 pounds or I'll be below the 35 min. I've seen so many complain about how counter-intuitive this is (I did too), but some people have to go through so much more than 'not losing weight' to get ins. approval that it's laughable to complain about this. It's a stupid rule, but if it will get you ins. coverage, it's a small issue. I should say that I've seen some ins. co.'s that want to see a certain % of weight loss and they do want you to succeed. Those stories are less common, and I'm not sure even then if you can go below your min. BMI.
- If you're in the 35-40 BMI and need comorbidities make sure you understand how many you need, which ones 'count' and which ones just 'help your case', and what makes them count or not. For most people's ins. the only ones that count are Type 2 Diabetes, High Cholesterol, High Blood Pressure, Sleep Apnea, and Obesity related Heart Issues (there are a few rare conditions like certain obesity related cancers, brain pressure disorder, that MAY count). You have to show TREATMENT for these to count (ie. you are on meds for High Blood Pressure, CPAP nightly for sleep apenea). The other comorbidities just help your case but don't get you a check mark for your requirements (ie. I also have Adult onset Asthma, Osteoarthritis, Stress Incontinence and none of these count).
-The 6 mo. diet has to be 6 CONSECUTIVE months within 2 years of your surgery date. I've rarely seen people get Weight Watcher info. through, but it's rare (seems to be in CA). I've seen people denied for missing 1 visit and even someone denied for having too many days between visits.
- Make sure the PCP visits are CODED to the ins. co. as a WLS weigh in visit ONLY. Do NOT combine this visit with anything else (saw someone denied for one visit being coded as a sick visit...which she was sick, but ins. co. can see the codes and she didn't have a weight visit that mo.).
- Know "How long 6 mo." is. Sounds stupid, but do you need a full six mo., which would be 7 PCP visits including the initial weigh in, or do you need 6 VISITS (I found out half-way through that I only need 6 PCP visits- 1 each month, so it's really only 5 full months. Be careful, some ins. co.'s want 7 visits).
- Some need a weight history (showing you're over the BMI) longer than the 6 mo., I did not (some ins. want 2 years, some 5).
- Make sure all those other pre-op testing/visits (Psych, NUT, heart, Pulmonary, etc.) you do are within 6 mo. of your SURGERY DATE. For most ins., any more than 6 mo. out and you'll have to re-do them. Many people are anxious to get started and do some of these too early. Remember, after your 6 mo. you have to include the approval process and then estimate your surgery date before you start these visits (I waited 2+ months before starting).

Good luck all, and let me know if you have any questions about the above! -BG

Sparkles · 02-27-2009, 09:51 AM

Quote:

Originally Posted by JustJoy

It pays to be proactive and have those ducks in nice neat rows. Insurance companies have lots of little loopholes that are annoying as heck. This is why I decided to do my diet follow-ups with the bariatric center (2 hrs one way) rather than in town with my PCD, I don't want to take *any* chances for the documentation to be lacking and have to start over.

Joy

OoOo maybe I should do that too! Thanks for the tips! I will try this. I guess until they tell me stop or I get annoying lol.

Sparkles · 02-27-2009, 10:18 AM

Quote:

Originally Posted by Band_Groupie

I think I read all the posts here, so I'll tell you what I've learned (I go for my 5th PCP visit on Monday). I messed myself up at the beginning not knowing all of this and lost two months that I had to begin again. This is probably way more info. than you need, but if it helps someone...
- If you haven't already, call your ins. co. and get a copy of your bariatric policy so you know their rules. Most can show you how to download it online even, or they can send it to you (you have a right to a copy).

The rest of these apply to my case and what I've seen from others, but your ins. may be different:
- Personally, I've found the insurance person at my surgeon's office to be the best source of information since she deals with my ins. co. all the time. Call that person with a list of your questions...ie. your ins. co. will never tell you or spell out in their policy that they expect you not to lose below the minimum BMI, and the ins. expert at your surgeon's office can't legally tell you that either, so word your questions carefully and listen to what they DO say...mine said "If you fall below the minimum 35 BMI then you wouldn't need the surgery would you?" I let her know I got it and she was visably relieved (I've seen lots of posts where people don't get it).
- Make sure you're well over the min. BMI you need (35 or 40) at your first weigh in (I learned this the hard way and had to start over...was 1 pound below). Eat a big meal, wear heavy layered clothing, drink water until you're ready to burst, wear your cell phone and put your wallet in your pocket (like men do).
- Get a seperate form from you surgeon to use at the PCP visits. The surgeon should have a sample to use, if not let me know. You'll turn all these seperate forms into the surgeon along with the PCP letter of 'medical necessity'. I have my PCP keep a copy and I take the original and fax it to my surgeon's office. Not keeping this on a seperate form is risky as the regular 'Doctors notes' that they keep in your file may not be enough or they might forget to note something as simple as your weight that mo. I've seen people denied for their Dr's. notes being incomplete even one mo.
- The monthly visits also have to include doctors notes on EXERCISE program. This gets a lot of people denied. Just have them make a note on what they've asked you to do (ie. 30 min 4x a week) and how well you did with exercise last mo.
- Make sure you know if you are allowed to fall below the minimum (35 or 40) BMI during your 6 mo. (see second bullet point above). None of the three hospitals I intitially looked at wanted you to lose more than a few 5-10 pounds and not go below your min. BMI. I can only lose 10 pounds or I'll be below the 35 min. I've seen so many complain about how counter-intuitive this is (I did too), but some people have to go through so much more than 'not losing weight' to get ins. approval that it's laughable to complain about this. It's a stupid rule, but if it will get you ins. coverage, it's a small issue. I should say that I've seen some ins. co.'s that want to see a certain % of weight loss and they do want you to succeed. Those stories are less common, and I'm not sure even then if you can go below your min. BMI.
- If you're in the 35-40 BMI and need comorbidities make sure you understand how many you need, which ones 'count' and which ones just 'help your case', and what makes them count or not. For most people's ins. the only ones that count are Type 2 Diabetes, High Cholesterol, High Blood Pressure, Sleep Apnea, and Obesity related Heart Issues (there are a few rare conditions like certain obesity related cancers, brain pressure disorder, that MAY count). You have to show TREATMENT for these to count (ie. you are on meds for High Blood Pressure, CPAP nightly for sleep apenea). The other comorbidities just help your case but don't get you a check mark for your requirements (ie. I also have Adult onset Asthma, Osteoarthritis, Stress Incontinence and none of these count).
-The 6 mo. diet has to be 6 CONSECUTIVE months within 2 years of your surgery date. I've rarely seen people get Weight Watcher info. through, but it's rare (seems to be in CA). I've seen people denied for missing 1 visit and even someone denied for having too many days between visits.
- Make sure the PCP visits are CODED to the ins. co. as a WLS weigh in visit ONLY. Do NOT combine this visit with anything else (saw someone denied for one visit being coded as a sick visit...which she was sick, but ins. co. can see the codes and she didn't have a weight visit that mo.).
- Know "How long 6 mo." is. Sounds stupid, but do you need a full six mo., which would be 7 PCP visits including the initial weigh in, or do you need 6 VISITS (I found out half-way through that I only need 6 PCP visits- 1 each month, so it's really only 5 full months. Be careful, some ins. co.'s want 7 visits).
- Some need a weight history (showing you're over the BMI) longer than the 6 mo., I did not (some ins. want 2 years, some 5).
- Make sure all those other pre-op testing/visits (Psych, NUT, heart, Pulmonary, etc.) you do are within 6 mo. of your SURGERY DATE. For most ins., any more than 6 mo. out and you'll have to re-do them. Many people are anxious to get started and do some of these too early. Remember, after your 6 mo. you have to include the approval process and then estimate your surgery date before you start these visits (I waited 2+ months before starting).

Good luck all, and let me know if you have any questions about the above! -BG

Band_Groupie! Goodness gracious thank you for the great information. I didn’t know there was such a thing as a code for a WLS PCP Visit. I will ask that nurse to look it up and make sure my charts state that. If you have that form I would love for you to send it to me.

Band_Groupie · 02-27-2009, 02:24 PM

My scanner is on the 'fritz' right now, so I'll give you the info., to be filled out ea. month and sent to surgeon's office

DIET & EXERCISE PROGRAM PROGRESS NOTE
Patients Name__
DOB ____
Date Of Visit____
Date Diet Initiated___
Patient is following a ____kcal/day diet, Other____
Patient is participating in the following exercise regimen ___ (Walking, Swimming, Curves, Yoga, Aerobics, Gym membership, Other, Patient is unable to exercies due to ___)
Vitals: Height___ Weight___ HR___ R____ BP___
Morbid Obesity ___ (check mark here)
Changes in weight since last visit ___ pounds (Lost, Gained, No change)
Continue to follow a ___kcal/day diet, Other___
Continue to exercise___
Return to office in one month to evaluate progress ___
Other________________________________(This is where they fill in education, lifestyle changes, discussion of comorbidities, sleep importance, other things ie. cutting back on soda, coffee, etc....ins. wants to see you're learning what will be necessary)

Tess · 02-27-2009, 03:52 PM

Well I just left the surgeons office. Everything is handled by the center thats doing my surgery so I'm not worried about it. They do it all the time and deal with the insurance companies so they know.
She told me not to worry about losing any weight. The insurance company justs wants to see that I'm committed. They want to make sure I am educated about how I will need to learn to eat and maintain the surgery. Learning nutrition.
The two weeks before the surgery I will lose weight because of a two week liquid protein diet. Thats for my own safety. To get rid of any fat around my liver for the surgery.
As far as losing weight until then, its not that important. She said 10 lbs. will be fine. They have never had anyone turned down unless they gain weight and don't attend the classes. I feel so much better now. I go for my Phyc evaluation, physical and Nutritional March 19th. That will be my 6 month start date. If all gos well... I will be having a fall surgery. Maybe Oct.