My Hospital, My Bariatric Program, My Surgeon

I live within driving distance of the Cleveland Clinic...the #4 hospital in the country. It's about an hour drive for me to get there. I have some good hospitals that offer good bariatric programs within my own city, but they all had program fees (above and beyond what the insurance covers) and I just couldn't afford it. I had heard so many great things about the Cleveland Clinic in general I decided to check them out as well.

Which brings me to AH-HA #1:
DO YOUR HOMEWORK. After you've researched and made your decision on what WLS procedure is best for you...don't forget to research surgeons and hospitals. Some people may be limited to what is in their area if they don't live in or near a larger metropolitan area. However, if you live in or near a larger city check out all of your options. There are three major hospitals that offer bariatric programs within my own city. I called each one and asked for all the basics: FEES, REQUIREMENTS, SURGEONS, INSURANCE. Most of them also had websites that already had answers to these questions. Once I gathered that information I was a little discouraged...they all had program fees ranging from $800-$1900. OUCH! So, I decided widen my search area and I came across the Cleveland Clinic. NO PROGRAM FEES! GREAT BARIATRIC PROGRAM! GOOD PATIENT FEEDBACK ON SURGEONS!

My Hospital: Cleveland Clinic.It has the Bariatric and Metobolic Institute that has a very thorough bariatric surgery program. This is how My Bariatric ProgramWorks:

1)You call and they pre-screen you by asking for your insurance information, height and weight, medical conditions (co-morbidities) and tell you if you qualify for WLS. If you qualify they send you a Patient Worksheet Questionnaire.

2) Once you send in the Questionnaire they review your medical history and make sure you are pre-authorized with your insurance for any pre-op testing and appointments.

3) If everything is kosher with your insurance they schedule you for the required WLS workshop

4) The WLS workshop is about 3 hours long. They encourage you to bring an immediate family member or support person so that they can learn with you. The workshop covers  all of the different types of sugeries; all of the pre-op preparation, life after surgery, and the expected lifestyle changes that come with each of the surgeries. It's VERY thorough. At this point they also assign you your surgeon and clinic ID.

5) After completing the WLS workshop you make appointments for your pre-op testing. These test can vary based on your health situation, but some of the basics that most patients will go through are
    - Bloodwork
    - EKG (to make sure your heart is stable for surgery)
    - X-Ray (to make sure your lungs are healthy enough for surgery)
    - Psychology (to identify and work through and mental/emotional issues that might prevent you from being
successful after your surgery)
    - Nutrition (to make sure you meet your insurance diet requirments, prepare you for the pre-op diet, and educate you on the new eating habits after surgery)
    - Meet your surgeon
They do their best to schedule these appointments in one day so that you don't have to keep coming back for each appointment.

6) Once all of these things are complete and you met all of your insurance requirements they submit all of your information to your insurance for approval.

7) Once approved they schedule your surgery and you come in for a Pre-Op clinic visit, which includes a consultation with your surgeon.

8) After surgery there are multiple follow-up appointments and support groups.

My Surgeon is Dr. Matthew Kroh. I've only met him once thus far, and it was very brief. He seems like a nice man. I know I will be meeting him again for a more in-depth consultation once my surgery is scheduled. I think I will get a better feel for him at that point.

Insurance

As I said in my Beginning  post my new insurance covers WLS...sort-of.

I have CareSource - Ohio. They only cover certain WLS procedures (Roux-en-Y and LapBand) and only on a case-by-case basis. When I first contacted them to see if they covered it the customer service rep said NO. Then someone (on the Obesity Help website) suggested that  I call again with the procedure code for Roux-en-Y (CPT code: 43645 - Roux-en-Y Gastric Bypass). When I did that they told me it's not usually a covered procedure unless it is deemed "medically necessary" by my primary care physician, and that I meet certain "requirements" for approval.

What are those requirements?

-9 month doctor supervised weight loss program (completed within the past 5 yrs). The doctor must document weight, dietary plan, exercise plan and progress on a monthly basis.
-Documentation of at least one obesity related co-morbid condition (diabetes, high blood pressure, high cholesterol, heart disease, sleep apnea, etc)
-BMI of 40+

•My BMI is over 50 - CHECK
•I have Diabetes, high blood pressure, sleep apnea - CHECK
•9 month doctor supervised weight loss program:

Right now I'm in month SIX...so only THREE more months to go! I know I shouldn't be too excited right now, because I'm not approved yet. However, I'm going through a program at the Bariatric and Metobolic Institute at the Cleveland Clinic and they are almost sure I will be approved.

The first six months of my "diet" (beginning Sept 2009) I started with my PCP and told her about my decision to have gastric bypass surgery. I told her all the information that needed to be documented and that she would need to write a recommendation letter. She agreed to work with me and also counseled me about the surgery (the pros and cons).

During the same time I had also signed up for the bariatric program thru the Cleveland Clinic. In November I went to a seminar and got registered with them and made all of my pre-op appointments. They handle all the insurance stuff and won't make appointments with-out pre-authorization from your insurance company. I double checked on this. Every appointment the clinic made I called their "insurance specialist" to confirm my insurance had authorized it...and every time (so far) it has. I haven't received a single bill. I will be continuing the last 3 months of my diet with the Nutritionist in their Bariatric Program.

Here's to hoping for approval!