May 26th, 10 days and counting ...

May 26, 2007

It's really starting to hit home now ... My surgery is June 5th ... 10 days from today. It's starting to feel like it's actually going to happen. I would say that I'm not worrying over it, but truth be said, I was up until 3:30 this morning. Nervous energy I guess. I've bought some protein, but I seem to be putting everything else off. I still need to get my sublingual B12, calcium, and multivitamins. (I'm not sure that I can have the children's chewables because I can't have any Iron, due to a heriditary condition called Hemochromatosis... I'm going to have to figure it out.) I have the list of stuff to pack, but I haven't done it yet. I need to "clean my room." I certainly can't let any of my friends see "clothes mountain" for heavens sake!

Next Friday, June 1st, I meet with the team at DukeWLS to go over last minute questions for surgeon, nutritionist and psychiatrist. It's done in a group setting so that we can all hear answers to the questions we forgot to ask. Then, I have the weekend to make sure everything's done and then ... Tuesday morning ... It's showtime.


I met with my surgeons yesterday. They answered most of my questions ... the ones they didn't answer are the ones I forgot to ask.  I knew about a lot of what we talked about. What to expect, how it's done, the need for compliance because it's only a tool not a solution. However, here are some things I did learn from my visit with the surgeons:

*  How many surgeons will work on me? There are always two surgeons; one on your right and one of your left. One surgeon drives, the other assists. 
* What is the experience of the other surgeon?  The other surgeon is a fully licensed, experienced surgeon who is doing a fellowship to specialize in bariatric surgery. My second surgeon has done more than 170 bariatric surgeries and is almost done with his fellowship. :-)

*  What goes into the decision to do the surgery Laproscopically vs. Open procedure? Surgeons don't "choose" to do an open procedure that is started laproscopically; they only switch to an open procedure when they cannot complete the operation laproscopically.

I'm sure there was more ... when I remember, I'll update this section.

* What is the expected hospital stay if you have a laproscopic procedure and don't have complications during or after the procedure? Two nights. Pain is managed easier than after an open procedureand recovery is usually 3 weeks or less.

* What is the expected hospital stay if you have a laproscopic procedure and don't have complications during or after the procedure? 4nights. An open procedure is more painful. There is a signicantly higher risk of infection and hernias. Recover is slower than after a lap procedure and recovery is usually 6 weeks or more.

Wear the CPAP or No Surgery!

May 19, 2007

My surgeon is not kidding. If you have been prescribed a CPAP, you need to have been using it for AT LEAST 2 weeks before surgery and bring it to the hospital. If you don't do both of these things, you can pack up and go home. He's known to cancel surgeries for messing this up.

I'm using mine and I'll be sure to take it with me ... I'm adding it to my take it to hospital checklist I'm going to go over before we leave the driveway!

You're Approved and Scheduled for Surgery!

May 10, 2007

Tues, May 9th "Your Approved"
Wed, May 10th "You're Scheduled"

It still doesn't seem real yet. Maybe when I go in for my appointment with Dr. DeMaria, on May 25th, it will seem more real. I will see him for about an hour to discuss my procedure, let my husband and I ask questions. (Inviting me to ask questions can be dangerous ... I think I have 3 pages so far and I'm not anywhere near done ,,, Not that I haven't already researched it into the ground. 

I have the what to take to the hospital lists ... Of course I'll probably get more information when I go for my pre-op appointment on June 1st. The pre-op starts at 7:45 am. I'll see the Dr's and sign the consent forms. Then I'll meet with the Diet/Nut in a group Information Q&A forum, Finally, I'll meet with Pshyc group for a similar Information, Q&A with others scheduled for surgery. Once I've seen everyone at DukeWLS I have to go to Durham Regional Hospital to meet with the anesthiseologist.

I have to call June 4th to get my surgery time. I actually hope it will be an early call. Otherwise, I may well worry myself into a puddle.

Adressing Worries ...

May 10, 2007

I truly believe that this is my best chance to live a long and healthy life, but it scares me beyond belief
 Will I Die
 - I reassure myself with the knowledge that 
my surgeon who has done thousands of procedures during the past 15 years and 
- is a leader in his field and develops and refines methods to ensure the best outcomes possible

Pain after surgery
 - I reassure myself with the knowledge that 
pain management  techniques such as the morphine pump will be available.

Complications after surgery -Short and long term  
- I reassure myself with the knowledge that 
I am relatively young (49), healthy and strong.

Not attaining a "successful weight loss
 - I reassure myself with the knowledge that 
I am already taking steps that I need to assure that I will be success at losing a meaningful amount of weight that will allow my body to function better.


Regaining the lost weight
 - I reassure myself with the knowledge that 
the first few months after surgery I am going to lose weight through compliance and accountability using to document my weight, food choices, and activity.


Paperwork has been submitted to insurance for approval ...

Apr 25, 2007

Today is a good day! 

Beth from DukeWLS let me know that my information has been submitted to my insurance carrier for their review/approval. 

I wanted to know what my financial responsibilities would be before I get there … at least as much as possible. I wanted to know what the worst case scenario would be. So before I called the insurance, I called DukeWLS and spoke with Beth … she handles the insurance submissions for Duke Weight Loss Center. She was really very helpful and gave me pretty much "word for word" the information/questions I needed to get the coverage information I wanted to get from my insurance carrier. It is so much easier to deal with them when you know the right information to give them when they are looking up your providers and the right questions to ask to ascertain what your liability will likely be. Of course, you will have different coverage, but I think the information that Beth gave me would work for just about anyone who wants to be sure that you are getting the correct information from your insurance carrier. I hope that this will be as helpful to you as it was to me! (Thanks Beth!)

This is the information I provided my insurance carrier to get a straight answer about what they pay and what my responsibilities would be:

  1. Call the insurance carrier’s medical benefits customer service department.
  2. Obtain the name (first, last), ID number and location of the customer service representative.
  3. Document the date and time of your call.
  4. Tell the customer service representative that you need to determine coverage for inpatient surgical services.
  5. Provide the customer service representative with the tax ID # for your doctor and/or his surgical office. This is a unique identifier and should reduce confusion about which Dr/Practice your are getting information about.
    1. Ask the customer service representative if the provider is in network or out of network?
    2. Ask the customer service representative for the dollar amount or percentage of your co-pay?
    3. Ask the customer services representative to tell you the co-pay dollar amount or percentage you will be responsible to pay for surgical services, if billed separately? If the Dr. has a different tax ID number than the hospital, the Dr's surgical fees are billed probably billed separately.  
  6. Provide the customer service representative with the tax ID # for the hospital your doctor uses
    1. Ask the customer service representative if the hospital is in network or out of network?
    2. Ask the customer service representative if there is a dollar amount or percentage co-pay for inpatient services?
    3. Ask the customer service representative to list what they define as inpatient services? Different insurance companies might define what they pay for with "in-patient" services differently depending on the policy you have and any limitations or exclusions that might be a part of your particular policy.  

Armed with the tax ID information that Beth, the insurance specialist, provided and the questions she told me to ask, I contacted my health insurance carrier to see if I could finally get some clarification on my surgical expenses. 

Eureka ! With the right information and questions, I got the answers I needed. The only real unknown for me, is what the insurance considers “reasonable and customary” fees. Everyone has different clauses in their insurance so, I'm sure mine is somewhat different than others, but just to give you an idea of what I'll have to pay .... I’ll have fixed co-pay for the hospital and a percentage co-pay for the surgeon’s fees. I also have a maximum total out-of-pocket dollar on what I have to pay. Once I hit that ceiling, my insurance covers @ 100% of the “reasonable and customary” fees. You have to be careful with that. It doesn’t necessarily mean that the insurance will cover 100% of the bill, so you may be left with any additional amount above what the insurance considers “reasonable and customary.”

Once my package was submitted to the insurance I called to be sure that they had everything. Then left it alone for a about a week. After that, I called twice a day. Each time I called I asked for the Care Coordination office. Wrote down the Date, Time, Who I spoke with and their location. I got that info before I gave them my information, so that I'd get it all down.

Moving forward ... a step at a time.

Apr 12, 2007

Well, I met with the Kelly for my psych evaluation, she was personable and I was very pleased with her cautious approach. I believe that I am ready to do this, but I invite the caution of all of the health care team. I also have done the physical, with the Connie the nurse, again very comfortable with Q&A, it was very give and take. I spoke w/Patrick the nutrionist and it looks like we are on the same page. Now, they have all my labs and sundry tests done and submitted. They need to do one more medical consult regarding my Hemochromotosis. I, and everyone else wants to be sure that if we proceed that we are looking at all factors that might impact which procedure I have done. They also need to get one more lab result returned. Then my "packet" goes on to the medical review at Duke WLS Center. Beth, in the office said I should expect that it will take approximately one week in review ... But hey, the packet has to get there first. Duke has not been dragging their heels, I have. I have had some other family members that other health issues that required attention, and I'm not about to undergo this procedure until I can give it my full, undivided attention. I don't need any additional stressors, if you know what I mean.

I believe that I will be accepted in the program and I also believe that I will be approved for my procedure. If not the first, time ... :-)

Until next time, all the best ... anyone who wants to contact me is welcome.

P.S. I have started seeing a counselor on a regular basis re: me and my not so good friend "food."  I joined Curves and I'm going to join a gym that is a side benefit of my health plan ... who knew! ;-)

Looking for and finding support

Mar 21, 2007

I am finally starting to leverage the power of OH. I was just kind of "floating" here for the 8 months or so. I had gone to some of the various forum chat rooms and sort of felt like a kid on the out side of school fence watching the kids play a recess ... close, but not a part of the club and unable to connect.  Well, finally "the light went on" and I decided to look at my local state forum ... 

I'm glad that I was on this forum. I graciously invited to attend the Support Group for the UNC Chapel Hill program...Thanks Diane!

I went to a support group at UNC Chapel Hill. They had about 8 to 10 people there ... a couple of people had just had there surgery and were a few weeks out ... one who had their surgery and was several months out ... and a couple of people who were awaiting surgery. One person said they would not do it again because they are not seeing the results they are looking for. The others definitely would. It was interesting to hear the different perspectives. I could see some of the pitfalls and some of the successes. I was definitely food for thought. Over all, a very positive experience. 

I have signed up for the April support group at DukeWLS. The topic is addresses psycho-social issues ... I think it will be a good topic. I plan to attend all of the support groups the DukeWLS provides. I may also look for another here in Raleigh.

I have also found several people who have asked to be friends ... Now, I'm on the playground participating, instead of just watching from the sidelines. Thanks to those of you who have graciously extended the hand of friendship.

March 9, 2007 - Step 2 ... Evaluation continued

Mar 09, 2007

I went in for the evaluation today ... I saw the RN. Her only concern is my chronic depression, but she thought I had  realistic view of what to expect and how to manage it. Next, I saw Psych. ... I have a long history with severe clinical depression. There is warranted concern that I'm emotionally healthy enough to undergo the rigors of surgery that the losses and life adjustments necessary to make this work. I believe that I'm strong enough to do this now with the support of my Pysch and counselor.  The suggestion to move the counseling session to a weekly basis once approved and throughout the major changes is a good one. I understand that I have used food as a beloved crutch during happy and sad times. I'll have to deal with the fact that I'm going to give it up for a longer, healthier existence ...While that is 
"Why" I'm doing this, I understand I'm really going need help in the how to do it.

I didn't get to see the nutrionist yet. Apparently, he'll contact me next week. 

It is my understanding that the medical review team will check to be sure that all required tests results are available and that they have discussed my emotional health/stability prior to determining if I'm eligible to participate in the program.. I understand that it takes about 2 weeks to complete the review process...I'm thinking it might take just a bit longer considering that they need to contact my mental health professionals.

The told me that the next step involves insurance processing. I need to figure out when I actually speak to a surgeon about options.

Soooo.....The waiting game starts.

March 9, 2007 - Step 2 ... Evaluation

Mar 08, 2007

Tomorrow I'm going to DukeWLS for my evaluation appointment. I have filled a out a bunch of paperwork and I'm taking copies of all of the test results they have asked for, just in case things weren't forwarded from one of the Dr.'s offices. I also stopped at my pharmacy and asked them to print a list of all my meds.

I understand that I'll be seeing the nutritionist, psychologist and a round-table with the medical team and others seeking WLS through Duke. I'm not too sure when you find out if you are accepted as a candidate, go through the insurance stuff and actually get a date.

About Me
Raleigh, NC
Surgery Date
Jul 27, 2006
Member Since

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