33 and Tired of Being Overweight - VSG Scheduled for 12/15/16 - Richmond, VA

This is a long one...it covers my decision to have...

This is a long one...it covers my decision to have surgery and the process to get it covered by my insurance.

I'm an (almost) 33 year old woman who's been overweight my entire life, and morbidly obese for most of it. For reference, I'm 5'9" and my highest weight was 328. I'm currently at 311. Over the years I've tried to lose weight with Weight Watchers, Medifast, working out with a personal trainer, Atkins...the list could go on. I never lost more than 25 lbs, and regained everything I lost each time.

I'd considered weight loss surgery five or six years ago, but wrote it off as too expensive - my insurance at the time didn't cover any bariatric expenses. I changed jobs in September of last year, and found out that my new insurance DOES cover weight loss surgery.

January 2016 was the start of my journey to learn about my surgical options and to qualify for insurance approval. I attended a seminar lead by one of the surgeons in a local bariatric surgery practice that covered the differences between the three main surgery types, their risks, and the potential benefits that come with losing weight. The practice has a dedicated insurance coordinator who knows the ins and outs of qualifying for surgery with the insurance carriers in our area. When I registered for the seminar, I was asked my insurer (Anthem) and employer, and when I arrived I was given a packet of information that outlined the requirements specific to my situation:
- documented history of obesity for at least three years
- six months of supervised diet and exercise with my primary care doctor
- a letter of recommendation from my doctor
- a list of all the things I've tried to lose weight over the last five years (including how much weight I lost and regained on each)
- a letter written by me that talks about how being overweight affects me and how I think life would be different if I weren't overweight
- a meeting with a nutritionist/dietitian
- a psych evaluation
- a meeting with a nurse practitioner from the surgeon's office

It was nice to have everything all laid out for me like that...but it's also really daunting to see the whole list at once. I wasn't 100% sure that I wanted to have surgery yet, but decided to start the 6 months of doctor visits while I decided. If I did choose to have surgery, I didn't want to wait any longer than I had to.

I started my monthly doctor visits at the end of January, and they were pretty uneventful. I already had a pretty solid exercise routine established, so she encouraged me to stick to even more of a schedule with that than I already did. She recommended a reasonable eating plan (whole/unprocessed foods, increase protein and decrease carbs, basically) and did blood work to check all the basic things along with my levels of various vitamins. Turns out that a family member of hers has had weight loss surgery, so she's gotten familiar with the nutrients that can be problematic after surgery. She wanted to check my levels of those so that if I was deficient she could help me get on track so I would be going into surgery in the best position possible. I was low in B12 and iron and abysmally low in vitamin D, so she put me on supplements for each of those.

Visits 2-6 were pretty standard - weight check, talking about how I was doing on the diet, etc. I did freak out at visit 3 when I'd gained a couple of pounds - my insurance documentation said that I was not allowed to gain weight, and I thought I'd just blown my chances and would have to start the 6 months over again. The doctor pointed out that I had been on a medication for a couple of weeks that's notorious for making you retain water, and that the insurance people probably meant you couldn't end the 6 months heavier than you started, NOT that you absolutely couldn't gain weight from one month to the next. That calmed me down. :)

About 4 months in to the 6 months of visits, I had done enough research that I was confident that I *did* want to pursue surgery. I had initially thought I wanted the Lap Band, but changed my mind pretty quickly. The success rate wasn't as high as the other surgeries, and I just felt like I had too much weight to lose for the band to be a good option for me. Once I made the decision to proceed, I called the surgeon's office and scheduled a meeting with the nurse practitioner and the nutritionist on staff. The insurance coordinator provided me with a list of local therapists who have experience doing psych evaluations for bariatric surgery patients, and I called and made an appointment with one.

The meeting with the nurse practitioner was uneventful - basic health history, height, weight, etc. She asked which surgery I was thinking about and I mentioned my thoughts about the Lap Band for my particular situation, and that I'd decided I was most interested in the sleeve gastrectomy. She confirmed that I was a good candidate for VSG. The meetings with the nutritionist and psychologist were also straightforward. I've been on antidepressants for years, so I have an established relationship with the NP who prescribes those for me, as well as a therapist I've been seeing for quite a while. The psychologist said she had no reservations clearing me for surgery, but that it might speed up the process with insurance approval if I proactively included notes from my NP and therapist saying that THEY would also recommend me for surgery. I requested those notes, and they were happy to oblige.

Once all the providers had faxed all their notes in, I was done! Or so I thought. The insurance coordinator sent everything over to Anthem for approval, and they said that their requirements had changed. Thankfully the only added requirement was that I had to meet with the surgeon who would be performing my procedure so that he could review and sign off on everything. I had to wait a couple of weeks for that appointment, but it was very short and to the point when it happened. He said they'd send over all the documentation, and that once I was approved I'd get a letter with my surgery date and the dates for a bunch of other things - a four-hour nutrition workshop, lab work, EKG, another meeting with him to discuss the hospital stay and recovery, etc.

On Friday 9/16, the insurance coordinator emailed to let me know that she'd sent over all 56(!) pages of documentation to Anthem, and that it usually takes 2-4 weeks to hear back. On Tuesday 9/20, a nurse from Anthem called to let me know that I was approved! I'm so thankful that it was such a quick turnaround...I was on pins and needles expecting the worst.

I called yesterday and scheduled my surgery date for 12/15. I could have done it in mid-November, but pushing it back a month will mean I won't be on the liquid diet yet for Thanksgiving, and will mean I'm having the surgery during our least busy time at work so I won't feel any pressure to come back before I'm totally cleared (not that I expect work would pressure me anyway - they've been great.)

If you've made it all the way to the bottom of this...virtual high fives to you! I promise future updates won't be so long. Thanks for reading!

HW - 328
CW - 311

Dates set for all the pre-surgery requirements...this is getting real!

I got the official letter in the mail from Anthem at the end of last week saying that I was approved for surgery - I don't think I've ever been more happy to see a piece of paper in my life! Even though they'd already approved me over the phone, it's a relief to see it in writing.

When I called to schedule the surgery, the insurance coordinator also scheduled me for a required 4-hour nutrition workshop on November 10th. She said she would follow up with a letter that had the dates and times for all my other required pre-op appointments as soon as she'd called and scheduled them with the hospital. I got that letter yesterday - she's kindly scheduled everything on the same day, December 1.

I'll start the day doing pre-admissions testing and paperwork. I'm to have an EKG, chest x-ray, regular blood work, an arterial blood gas (not looking forward to this - I've heard horror stories!), and possibly an abdominal ultrasound. It didn't specifically say so, but I'd imagine I'd meet with the anesthesiologist or someone from his/her office at some point during this appointment.

In the afternoon, I meet with a nurse practitioner from the surgeon's office to do a medical history and a physical (even though I just had one in February.)

Right after that appointment, I meet with my actual surgeon to discuss the hospital stay and recovery.

Last time I met with the surgeon, he told me I'm welcome to bring someone with me to any appointments that I'd like, and that bringing someone who will be involved in my recovery is recommended when I meet with him again. I (and my cat, haha) will be staying with my parents for at least a week after the surgery, so my mom is going to come with me to the surgeon's appointment. She's also going to come to the nutrition workshop, which I think could be really helpful since it will hopefully give a clear picture of what eating will be like for me post-surgery. I don't think she would ever consciously try to tempt me into eating things I shouldn't, but this could be a good reinforcement of how I *should* be eating and why.

On a practical note, I'm working on drafting a durable power of attorney and living will. I fully trust that the surgery will go perfectly well, and I know that the chance of complications so severe they'd leave me incapacitated is almost nil, but it still seems a smart choice. What can I say? I'm a planner.

Kicking the soda habit

I'm just hanging out in the space between jumping through insurance hoops and doing pre-op classes and testing. I have a little over two months to go, and I'm starting to really focus on getting rid of soda. I switched to diet soda from regular a good 15+ years ago, but I knew it still wasn't good for me. I've tried to give it up in the past without a lot of success. With the surgery ahead of me and knowing I won't be able to have it afterwards, I have a lot more of an incentive to get rid of it once and for all.

I bought some sugar free Hawaiian Punch and Crystal Light on-the-go packs to add to bottles of water. My plan is to drink plain water unless I'm seriously jonesing for a soda fix, and then have a bottle of the flavored stuff.

Anyone have any tips for how to get past soda cravings?
Glen Allen Bariatric Surgeon

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