Preparing for Your Visit
Your Consultation To-Do List
If you believe you're a candidate for weight-loss surgery and would like to pursue this treatment, you need to do the following:
- Call your insurance company to see if this is a covered benefit for you and get a written copy of their requirements.
- If a six-month, medically monitored diet is required, call our office to get more information. We can also refer you to physicians within Jefferson who work with us specifically to help patients fulfill this insurance requirement.
- Call our office to make an appointment for your initial consultation with the surgeon and dietitian.
From that point, we will guide you through the process and set up your entire pre-operative workup. When your work-up is completed, your insurance is approved and you are ready for surgery, we will set a surgery date for you and schedule a final preoperative appointment. At this appointment, we'll work with you to complete all paperwork and surgical consent forms and address all of your questions. In addition, you'll meet with the dietitian again to discuss the pre- and postoperative diet plans and answer any diet/nutrition questions you may have.
Along the way, if you have any questions, simply call our office at 215-955-0020.
On the Day of Weight Loss Surgery
The morning of your bariatric surgery, you will come to the Hospital and be registered. You will then go to the surgery preparation area, change out of your clothes and meet your Jefferson anesthesiologist. We will confirm the completion of all paperwork and finish any last-minute preparations.
From there, you will go to the operating room. Your bariatric surgeon will talk with your family or companions immediately following the procedure. Assuming all went well in the operating room, you will go to the recovery room for a short time (one hour) following the procedure, then to your room.
In your private room, there will be a monitor to watch the oxygen levels in your blood and your heart rate. You are allowed visitors in your room after your nurse has assessed you and settled you in. At this point, you may have a urine catheter attached to you, as well as a small oxygen tube at your nose. You will be expected to get out of bed that evening and even walk in the halls if you feel strong enough. You may have ice chips, but nothing substantial by mouth.
The morning after your bariatric surgery, you will be taken to the radiology suite to have an upper GI X-ray. This will require you to drink some contrast while the X-ray is being done. Assuming that your X-ray looks normal, you will be allowed to sip clear liquids and take protein supplements. From that point, it usually takes gastric bypass patients 24 hours to feel comfortable drinking (that is, to drink without experiencing nausea or vomiting).
Once you are tolerating your liquid diet and walking adequately and your routine lab work looks okay, you will be discharged. The hospitalization for a laparoscopic Roux-en-Y gastric bypass is usually two days (that is, you go home two days after surgery).
Bariatric surgery is a unique insurance coverage. However, if you meet the NIH (National Institutes of Health) criteria for bariatric surgery, many insurers do cover this service. When it comes to weight-loss surgery, every insurance company and policy is different and requires different things from patients to obtain approval for a procedure.
The process of obtaining insurance approval for your surgery can be long and frustrating. Perseverance is essential to completing the process and obtaining approval. As you start your weight-loss journey, it is important that you remember the following:
- Your experience is your experience and may differ from another person.
- Your insurance policy is not the same as everyone else's policy.
- You are the customer of your insurance company – and you are your best advocate. Know your rights as a customer. Demand answers and information from your insurer that they are obliged to give you.
Your first step is to call your insurance company's customer service number and ask if obesity surgery is a covered benefit in your policy. Be aware that your insurance company may state, "No, only unless medically necessary." If that is the reply, then you do have bariatric surgery benefits. If you meet the NIH criteria, the procedure is considered medically necessary. You may also be able to reach your insurer online and get this information.
Getting Approved for Surgery
If you have coverage for weight-loss surgery, you need to obtain a written copy of your insurance company's requirements to be approved for weight-loss surgery. You will have to complete these requirements to be approved. In many cases, the Jefferson Bariatric and Metabolic Surgery Program does not have the same requirements. However, you must still meet your insurer's requirements to be approved, and we will help arrange completion of these requirements. If your primary care physician helps in this regard, please have those records sent to us, too.
Most insurers will require:
- Medical records. You will need to obtain these prior to your first visit with us.
- Any records of a required weight-loss program you have already completed.
- ALL medical records from your family physician and other specialty physicians for the past five years.
- A primary physician support letter. We can help guide you in obtaining this letter, which should state that your primary care physician is familiar with you and your obesity problem and that surgery is a good option for you.
- A nutritional evaluation and a psychological evaluation. We will arrange for you to have these.
Some insurers also require a six-month medically monitored weight-loss program. We can arrange for you to have this through Jefferson. Or, if you prefer and he or she feels comfortable doing so, your primary care physician can manage your Program. Some insurers have strict guidelines regarding this requirement. If your primary care physician will complete this with you, please let us know beforehand to help ensure your insurer's guidelines will be met.
What if Your Insurance Does Not Cover Weight-Loss Surgery?
If obesity surgery is not a covered benefit through your insurer, you still have the following options:
- You can contact your company's human resources department to request coverage specifically for your procedure.
- You can pursue other insurance options that do have the benefit.
- You can have the procedure on a cash-pay basis.