Surprises! On the scale, with labs, and an unbelievable itch!

The last week has been full of surprises.  Some were good, others not so much.  Last Wednesday I went for my annual physical, where they also draw my labs for the bariatric center.  For my non-WLS friends, because we no long absorb vitamins and minerals well (in addition to taking supplements) we have to have our blood checked for Iron, Folate, Calcium, Vitamin D, Thiamine, Copper, Zinc, and B-12 as well as getting a complete blood count, lipid panel, thyroid panel, and blood glucose level.  They drew 6 tubes of blood, went over my list of the labs I needed, and wondered why they hadn't seen me on a billboard advertising for my bariatric surgeon.  Awwww!  Some compliments never get old. 

The next day I got a call apologizing, but telling me they needed to take more blood.  They hadn't frozen some of the tubes immediately that should have been frozen, so they needed more blood.  Sigh.  OK, no problem, it is a complicated lab order.  The next morning my kids and I went in (we had the day off school for Yom Kippur - Happy New Year everyone who celebrates it) and they drew 6 more. 

Today, 6 days later, I got a call from them again.  Apparently, when the lab courier came to pick up the labs, he put ALL of my tubes in his freezer (not just the frozen ones).  So, they were all frozen when they got to the lab, and they weren't able to run the tests on the ones that weren't supposed to be frozen.  They apologized, and suggested that they send me a script to get them drawn and go directly to the labs to have them drawn to prevent another courier problem.  They don't know if the ones that were supposed to be frozen were run.  Sigh deja vu!  They will send the script to me, and we will try again.  I was actually hoping my results might be in the mail today.  Guess NOT.

On a positive note, I hit another all time low on the scale on Monday, and it blew me away.  139.8!  Under 140?!?  Incredible.  Unbelievable.  Whoa.  OK, so it's now back to 141, but I broke a barrier that I NEVER IN MY WILDEST DREAMS thought was possible.  My initial goal was to get to 160.  Then I hit the 150s and was really happy.  Then I broke into the 140s and I was over-the-moon dream-come-true happy.  I don't imagine I will be going down much further, I seemed to be very steady around 141 - 143 for the last 8 or 9 months - but then I've hit new lows several times in the last month or so.  I'm back at work, so I'm getting more steps in each day - that is helping for sure.  Who knows?  I'm just happy I'm not gaining anything back. 

Here's the bad surprise with returning to work.  I've got a rash.  A really itchy not-fun rash.  For non-WLS friends, we have a lot of extra skin after we lose 100+ pounds.  Some people have so much skin that it causes skin infections, and can interfere with walking, voiding, and sexual functioning.  Imagine a flap of skin that hangs down like an apron from your waist getting in the way of things and trapping bacteria and other fun things between it and the skin that is underneath it.  Yuck.  Having lost 103 pounds, I didn't seem to be having any problems with the excess skin (other than it making some muffin top and other flaps that my son thinks are funny to play with).  I didn't expect to have problems, mostly that happens with people who lose a lot more than I have.  Many WLS people get the extra skin removed ( it's called a panniculectomy, which is about 1/2 of what most people would call a "tummy tuck").  Between the risks, the cost, and the recovery I always said I wouldn't be getting one unless there was a real medical necessity.  Then I went back to work at my lowest ever weight (in 90 degree weather, walking around constantly)...  Hello, itch.  I've got a rash/ skin infection underneath the flap of excess skin hanging from my waist.  I'm treating it with the same anti-fungal medicine that you use for athlete's foot or yeast infections.  It helps with the itching a bit, but it hasn't gone away.  If it's still here much longer, I'll have to see my primary care doctor for something stronger.  And, that will start a trail of documentation.  If I have recurrent infections, my insurance may decide to cover a panniculectomy for me.  I don't want one.  The risk of major surgery, the 6 weeks of restricted activity in recovery, and the 20% of the cost I would still have to pay are three good reasons not to get it which wipe out the positive of being rid of the flaps.  However, if this rash is something I have to deal with on an ongoing basis, I will consider it.  Go away, itch!

Back to the positive!  I got to go visit some old friends briefly over the weekend, many of whom hadn't seen me for over a year (some not since before surgery).  It was really fun getting to have quick visits with them, and I would be lying if I didn't admit that I really enjoyed seeing their reactions to seeing me in my new healthy body.  Bonus.  I am so blessed to have such great family and friends, my home, my job and my health.

Today, 9/11, I'm counting my blessings.  Thank you for all those blessings, and may the hungry, homeless, out of work, and victims of violence find such blessings in the next year.  May I make the right choices to stay healthy, and be able to support others who need help.  May I learn from my mistakes and help my children avoid them.  May I find patience on the hard days, and give of myself on the good ones.  Thank you first responders, for risking your lives to save so many of ours.  Thank you to the members of the armed forces who serve their country - may you receive the support you deserve from us and our country.  Thank you to the teachers who are shaping our tomorrow. 

Bariatric Betty Talks Truth, Lies, and Money

I am three months out from surgery, and VERY happy with the results.  In addition to no longer being diabetic, I have lost 36 pounds since surgery, for a total of 66 pounds lost.  I have my 3 month checkup next week, and feel confident that they will be pleased.  They told me that the average person loses 50% of their excess weight by 6 months post-op.  I am 3 months out and have lost 40% of my excess weight (from time of surgery).  Yippee!!!  My energy is super high, my mood is improved, and I have the ability to do things I couldn't have done a few months ago.  I look forward to getting my labs done and making sure I'm doing well with my vitamins - I will be honest and say that I have forgotten to take them a few times (but only a few) and want to make sure my levels are good.

One thing about being three months out from surgery - all of the claims have been submitted, processed, and paid (as much as they will be) by my insurance company.  Watching this (and paying the remainders) has been very interesting.

For those of you who may not have been reading my blog since the beginning, I will suggest you take a look at my first few posts - probably starting with Bariatric Betty Gets Sucker Punched, and the ones immediately following.  To summarize, I will say that the first hospital's bariatric program (Hospital A) gave poor/ false information in their information session and after I was all psyched to begin my journey I found out the costs were more than DOUBLE what I had been told.  I then attended information sessions at Hospital B and Hospital C - eventually choosing Hospital C in part because of it's relative affordability, and partially because I was so impressed with the warmth of it's surgeon and staff, and it's low complication rates. 

The truth is two-fold.  The warmth and skill of Hospital C was genuine and fabulous.  The costs they estimated were not.  Did they knowingly give me false information?  I don't know.  I'm dissappointed that they didn't give me correct information - and given the extraordinary care I have received and continued to receive I prefer to guess that they don't know what really gets billed.  That leads me to think that perhaps I should think less harshly of Hospital A and their mistakes.   Maybe I would have found the same thing at Hospital B if I had gone there.  It really makes you wonder: DO DOCTORS AND STAFF AT HOSPITALS HAVE ANY IDEA WHAT THEIR PATIENTS ARE BILLED?  At least in Northeast Ohio, I would guess the answer is No. 

Hospital C told me that for my surgery (RNY Gastric Bypass, laproscopic) and the typical hospital stay (two nights, three days) I should expect that the total bill of about $22,000 - not including anesthesiology (which for some reason, none of the hospitals bills for - it's all billed seperately by the anesthesiologists).  I was told that the average anesthesiology bill for my surgery would probably be a couple thousand by my patient care coordinator, but since she doesn't work for the anesthesiology groups, that was the best she could do.  They also estimated (based on past experience with my insurance and this surgery) that I would need to pay about $3000 out of pocket all said and done, and took a deposit for that amount during pre-admission testing. 

Ready for reality?  I had 10 bills between preadmission testing and surgery.  Radiologists, labs, the hospital, the surgeon, the anesthesiologist, the doctor who check in on me before I was discharged.  Total bills?  $54,539.30!  Yup. 

Now, once my insurance calculated what was "allowable" under their contracts (this was all in network and pre-certified) the total recalculated amount to be paid was $19,946.26 (big difference).  My insurance paid $17,464.24 and I was responsible for $2482.02.  Of course, I have had to pay for the bills not directly through the hospital out of my pocket and have to wait another month or so to get my refund of the remainder of the deposit - so as of right now I have paid about $3600, but I should be getting over $1100 back (eventually).  And yes - all of these numbers included anesthesiology: it was originally billed at $2800 for the surgery and an additional $100 for post-op pain relief (a bargain) and was negotiated to just under $1300 total under contract). 

So why the discrepancies?  I can only figure that the person I talked to who does the billing to the insurance was looking at the negotiated rates when she gave me the quote of $22,000 (plus anesth.) even though I asked her what the difference was between the billed amount and the contracted costs - she only had one set of figures and gave me the impression it was the billed amount.  I ended up paying less than they anticipated out of pocket for as perfect an experience as I could have hoped for.  It's hard to be mad.  But it does make me ache for everyone who doesn't know how to read Explanation of Benefits (I used to do that as part of my job in my former life), and it did give me some stress during my recovery (like watching the amount billed and then PRAYING that the allowable amount would be signifigantly lower). 

As I watched things "in process" and "approved" and bills come in I knew I would want to blog about this when it was all done.  Why can't hospitals tell us all the costs?  Why can't they bill the contracted amount instead of inflated figures?  Why can't we understand the real cost of healthcare BEFORE it's given?  We need to be educated consumers, and I thought I was.  Still, I was surprised.  I know I was lucky - so many people want this surgery and don't have any insurance (or no coverage for bariatric procedures, specifically).  People in Canada routinely wait 6 months - 2 years for their free procedures - I started this journey only 9 months ago and had excellent teaching and guidance (part of which was mandated by my insurance). 

I don't have a solution for what's wrong with healthcare in America.  I do know it needs to be available to and affordable for everyone, and it is neither.  I know my insurance company (and myself ) will likely save tens of thousands of dollars now that I am not a diabetic.  I am worlds healthier and will live years longer than I would have without the surgery.  I pray that everyone else gets the opportunity to have life changing operations like I did if they need them. 

The Decision, and The Call

OK, so if you're a Weight Loss Surgery person, you know what "The Call" is and can skip the next paragraph.  If not, here you go.

I got two days of The Call.  The first one was yesterday, 1/30/2012, about 6 months after I went to my first information session about baritric surgery.  It was my patient care coordinator, Diane, from hospital C calling to tell me that my insurance company had finally pre-approved my surgery!  This is the call I've been waiting for - I finished my 90 days of multidisciplinary supervised dieting a month ago, and needed them to review all the documentation and say "Yes, she's compliant and fulfilled our requirements for pre-approval".  The second part happened today, 1/31/2012 about 15 minutes ago.  Sabrina, the scheduler called and said that they actually have an opening in the surgical schedule for Feb. 16th! 

So now that I have a surgery date, I'll call Feb. 16th my new Valentine's Day.  The one where I and my whole family say "You are worth this, we love you and want you to live a long healthy life".  I'll be honest, when I got the call about the insurance company approving me I broke down and cried.  In my car in the parking lot of the grocery store.  Several times.  It took me until my fourth phone call to family to stop crying each time I told them.  So the scheduler was supposed to call me in the next couple days, but they needed to make sure I understood that I would need to pay the $350 program fee and the $3000 deposit (because my insurance caps it's bariatric benefits below the cost of the operation) when I come in for pre-admission testing.  OK, I've been preparing for that.

I was so overwhelmed, I almost got in a car accident on the way home.  By the time it was dinner, I think I felt like a kid at the end of Christmas day.  Dazed, so happy to have gotten just what I wanted, but exhausted from the emotions of it all.

The scheduler called today, and I'm going in for blood work, EKG and counseling with the inpatient care doctor and nutritionist all day on Thursday.  Deal!  Can I pay the program fee and deposit in just two days?  If they take credit cards, I can!  (The answer was yes). 

So now things are clipping right along, and I'm going to be working like crazy to get everything prepared.  Coverage for the kids (my husband and mom will be helping), grocery shopping for them ahead of time - grocery shopping for my liquid diet post-op (noting NOT to overbuy - especially on things like broth, thank you guys for your blogs), and cleaning the house so my mom doesn't put EVERYTHING away where I can't find it when she comes to help.  Pre-op pictures - check.  The list is a living, evolving thing.  Suggestions are welcome!

I'm so excited!  And everyone I know is so excited for me.  I am blessed. 

Bariatric Betty's pride goes before a fall...

So, today I reached my 90th day of supervised dieting.  Hurray!  I've lost almost 20 pounds and I'm very proud of myself.  I emailed my patient care coordinator at Hospital C to make sure she had received the records she needed from my primary care doctor from 2008 and 2009.  She wrote back and said she received a packet, but it only had records from 1998-2004.  This was a big problem, because I need multiple years of weight history showing my morbid obesity for insurance pre-approval of partial payment of my bariatric surgery. 

So I got ticked that my past doctor's office could have screwed up my request so badly.  I wrote out specifically what I needed on the record release request.  I calmed down enough to call them and explained that there seemed to have been a mistake.  The woman at first agreed and then pulled my file.  Turns out there was no mistake, except my own.

I remembered going through a phase where I declined to get weighed because I was so embarassed with my weight.  Apparently, that phase was from 2004-2009, because all of of my visits during then don't have weight recorded.  So now because I was too embarrassed back then I might not have enough documentation to be approved my my insurance company.  I have data from my doctors from 2011, late 2010, and then 2004 and earlier. 

This afternoon I was able to get a copy of my record sent electronically from my old weight watcher's location in Central Ohio.  That gave me a starting weight in 1/2008 and an ending weight in 11/2008.  During that entire 10 months I lost just over 20 pounds.  Versus the last 90 days when I've lost just under 20.  I hope my earnest trying helps.  But now I'm really worried that since we don't have data from 2009, I may have shot myself in my foot.  What if my reluctance to face my weight in 2009 results in my not being approved for surgery?

There's nothing to do about it, but pray and wait.  My P.A. that is coordinating my multidisciplenary diet will be writing up his summary and putting together the packet next week.  Then the hospital will submit and we will wait.  And pray.  And try to remember that things will happen the way they should, even if I don't get approved. 

So here's my advice of the day.  Don't decline to be weighed, or have tests done.  Because you can't predit what will be needed in the future.  I never thought I would be looking at having this surgery, and now look what happened.  Pass it on. 

Day 75 and Bariatric Betty has a bumpy ride

So today I've been on my medically monitored diet for 75 days.  Depending on whose scale you're using, I've lost between 13.5 - 19 pounds.  When I met with Drew, the P.A. supervising my diet, he was pleased to see that I had lost 6 pounds in just the last four weeks.  Plus, he was really excited about my latest test results.  My Hemaglobin A1C has gone from 6.8 (really good for a diabetic) to 6.4 (GREAT for a diabetic) in the last three months and my insulin doses have been cut in half.  Then, he said - the next step is that you're going to go off your Novolog (insulin I take with my meals) altogether ."  I'm already down to 3 units with meals.  The next comment was "6.4, that's barely diabetic."  Ouch.  I said I was lucky that my insurance company wasn't making me diet for 6 months, or I might have a hard time qualifying.  He said "Well, for now you're still on three medications, and still diabetic..."  Whew.  No more labs before my case is submitted to the insurance company, and I will consider my self lucky.

A couple of days ago I got an email from my trainer.  She's left her job, and is no longer working as a trainer, but following her other love - photography.  As much as I'd like to be happy for her, she hasn't written up a summary of our work together, so I'm scrambling to print emails that I hadn't deleted yet and a couple comments she made while following my training on myfitnesspal.com.  My three month diet only satisfies the insurance company requirements if there is documentation of consults (at least three), behavioral modification sessions, nutritionist sessions (at least three), psych eval, and working with a trainer.  It specifically says "work with trainer may not be entirely remote (i.e. - online)".  And what I have proof of is from online.  My PA says that he talked to her before she left and is aware that we met in person once, and that he will write it up.  Just to be sure I'm covered, though, I'm meeting with another trainer this Friday.  He works at the same gym - I asked if he had access to her stuff or if I should bring copies of the program she designed.  He said "Oh, please bring it" - just like I thought, she left nothing....  

Oh, and if for some reason the insurance company doesn't think I've satisfied their requirements, I can continue to diet and have consults for three more months - but at that point I probably won't qualify because my diabetes would probably be diet controlled and have a BMI under 40. 

On a totally different note, I feel very blessed today.  Yesterday my father in law called.  He had gone to his doctor about pain in one leg and was sent to the hospital to get an ultrasound immediately, because the doctor suspected a blood clot.  He's 87 and in marvelous health for his age - very active and health conscious.  We just lost my mother in law this summer, and the thought of the chance of losing him so soon after was just crushing.  I sent a message out to my friends on facebook asking for prayers and was touched by how many responded so quickly.  Two hours later we found out that the ultrasound showed it WASN'T a blood clot after all!  So he still has to find out why it hurts, and we're a little worried about that - but the chance of a stroke has been pushed far down the list and we're so grateful for that. 

I have to remind myself each day; I have great faith in God.  I believe that God will see me through my journey in the best way.  I think that will include weight loss surgery, but maybe God knows something better.  I will keep reminding myself of this while I go through the last couple weeks of my supervised diet and the weeks waiting for the insurance company to make their decision. 

Bariatric Betty is happy to still be diabetic, but faces a sad reality.

Today I went for my 3 month check-up with my primary care doctor.  She hadn't seen me since I started the medically supervised diet (this is day 67 of 90).  She was thrilled with how I'm doing.  She agreed that I was right to lower my nighttime (long-acting) insulin when my morning numbers hit the 70's.  According to her scale I was 17 pounds lighter than 3 months ago!  I love her scale.  But, it lies.  I weighed myself three times at home before the 9:30 appointment this morning.  Once before I ate of drank anything and I was still in my pajamas.  Once after I drank 12 oz. of water and 12 oz. of diet coke (I will miss you, caffeine) and scrambled egg beaters with whole wheat bread.  And a third time after I was fully dressed.  Either her scale is off or I lost three pounds during the 1/2 hour drive to her office.  My scale is weighs me 1.5 pounds lighter than the one at the bariatric surgeon's office.  I'm not normally one to weigh myself numerous times in a day - just was wondering how much my weight fluctuated between eating / dressing/ etc. 

Anyway, she was really proud of me, and said she couldn't imagine how the insurance company would turn me down as a surgical candidate.  From her lips to God's ears!  I stayed and waited to hear my Hemaglobin A1C number... 6.4!  That is wonderful in many ways - first, it's the lowest it's ever been since I've been a diabetic.  Second,  while it shows my diabetes is marvelously controlled, it also shows I am still definitely considered a diabetic.  If it was under 6, my insulin would have been reduced (possibly discontinued) and then the question of my qualifying with the insurance company would have come into play.  Since I now have  a BMI under 40, I need to have at least one co-morbidity to qualify.  Diabetes is my only one.  Now I'm breathing easier, because my last set of labs before sumbission for approval from the insurance company show I'm still diabetic as well as compliant.  Yay!!!

Last night I got to go to my second local support group meeting.  It was just as fascinating as the first time.  Bunches of new people to meet, each with their own story.  Two women had lap-bands and one just a revision to the vertical gastric sleeve 6 weeks ago.  The other had hers a year ago and hasn't lost much weight or noticed it helping. Everyone was very encouraging and positive with her, suggesting that she talk to her new doctor about running some tests to see if the band is functioning.  One woman was a "lightweight" (BMI under 40) like me 15 months ago but has lost 90 pounds!  Another accidentally got pregnant just two months after her surgery.  Whoa.  Not recommended, but she and the baby are both fine.  She lost all the weight (including not gaining any during the pregnancy) she wanted to, and shared some great recipes with us.  She also recommended a latte machine at Bed Bath & Beyond for $30 - she said it reheats and reblends the latte during the day, and has a great recipie book with it that included a mocha latter with egg whites (it heats it enough that there's no samonela risk).  If I liked chocolate or coffee I would have been all over that.   Another woman who had just had plastic surgery to remove excess skin (and looked FABULOUS) and shared this recipe:
Kate'a Frozen Protein Treat
2 cups skim milk
1/2 cup greek yogurt
3 scoops unflavored whey protein powder
6 packets of splenda (or other sweetner)
1 1/2 cups of frozed strawberries

Blend and then pour in a sealable container and freeze.  She eats it as a high protein snack and said it's super.  THAT one I'm trying for sure.

On the topic of recipes, I came to a realization.  I may not be able to handle baking next year.  This may sound funny, but it's a huge tradition in my family.  We decorate our christmas trees with gingerbread, have a new year's eve cookie party for our kids and their friends, and after 3 years of practice I've finally gotten down the art of slovenian potica (a nut roll) making.  I'm very good at controlling my consumption of baked goods - it's before the baking that I am tempted.  Licking fingers and taste testing can sabotage a diet.  I've found a good way to handle it is to have other members of the family join me in the baking and to chew gum while I do it.  That works well for this year, but next year chewing gum will be a no-no (too much air being swallowed and the possibility of gum blocking my stoma) so I'm considering things like wearing a mouth guard, sucking on sugar free mints, etc.  Several of the members of the support group last night said that they can bake for their families without temptation now, so that gives me hope.  However, I have realized that if I find myself tempted, it would be better to give up this part of my identity than foil my brain re-training next year.  So I'll try; with company, mints, and mouthguards.  But if I taste one thing, that's it.  No more baking.  It's not worth ruining my tool.  And my friends and family would rather I was around than a plate of cookies.

For now I'm hopeful.  Hopeful I will qualify for surgery.  Hopeful I will make healthy choices and succeed.  Hopeful that I'm setting up good habits and supports that will help me in my new life.  And just having had Thanksgiving, I'm thankful that I not only have such a supportive family but that I found a way to work through all of this by blogging.  My thanks to you for reading.

2/3 of the way there and things are changing... maybe too much

Today is day 60 out of 90.  I've stayed adherant to my diet and exercise plan, and been under my calorie goal every day except for one (my sweet neighbor brought over delicious, warm, homemade rosemary bread - I am human!).  Depending on the scale and time of day, I have lost between 11 and 14.5 pounds, and my BMI may be as low as 39!  Coming down from 42, that's awesome. 

Here's a weird thing - my insurance wouldn't pay anything towards my RNY if I went below a BMI of 40 if I wasn't diabetic.  So in this strange case, being diabetic is a good thing.  My next change - wait for it - my diabetes is improving.  Yup.  I've been lighter than this weight before (right after I was diagnosed with diabetes 17 months ago) and my blood sugar was out of control.  About two weeks ago I had a morning fasting blood glucose level under 100.  That was only perhaps maybe the 4th time it's been that good.  Then this last week, every reading has been in the 80s.  This morning, at 7:30 am my level was 78.  That was actually a little scary, because I wasn't symptomatic for hypoglycemia, and I don't normally take my levels or eat that early in the morning.  They both usually happen an hour later.  This morning, if I had waited another hour, I could have had my blood sugar levels crashing. 

So my levels have been stable since then, and tonight I'm going to take less long acting insulin (10 units instead of 15).  I see my doctor and get labwork in 7 days, and with Thanksgiving this week, I don't think I could get in any sooner.  She and I had discussed adjusting my insulin if my numbers were low, so I feel comfortable with doing this change now.  Here's what I'm not comfortable with...

What if I am no longer considered diabetic in the next 30 days???  

On one hand - it's a wonderful possibility.  It's the major reason I wanted the surgery - to not be diabetic any more or have to worry about those co-morbidities.  I would live longer, be healthier, etc.  There's no reason I couldn't keep on my current diet. 

On the other hand, if I'm not diabetic, my insurance will no longer approve the surgery.  As it is, I will already have to pay about $5000 for the surgery.  Paying the whole $22,000 is not a possibility right now.  So I could have done all of this work for 90 days just to disqualify myself. 

Why do I need the surgery if I'm losing weight so well now?  Because I've always been successful at losing 20-30 pounds over 6 months or so.  It's when it gets to 9 months and out and I'm still not losing any more weight.  I get frustrated, and feel like being on the diet isn't worth it if I'm still obese with all the co-morbidities that come with it.  I have stopped dieting, and eventually gained it back. 

Having been through that cycle several times on my own, with Nutrisystem, and with Weight Watchers, I just don't know how I could handle it if it happened again.  I really want the tool of my new stomach - with a tiny appetite (at least in my honeymoon period) so I can train myself for my relationship with food for the rest of my life.  I want to dump if I eat too much carbs - to me the RNY is like implanting antabuse in an alcoholic; if you eat (or drink) the wrong thing you get sick, so you reinforce good behavior.   I want my pancreas to start making more insulin the day of the surgery.  I want the reset button to get pushed on my stomach so I know what it feels like to feel full (and not WANT to feel full). 

Well, I won't know what's going to happen until it does.  And just because I'm lowering my insulin dose doesn't mean I'll be off it soon, or off the glucofage.  So I shouldn't worry.  But it's like a little itch saying "what if..." in the back of my head.  On the positive side - being stressed raises blood sugar, so maybe just stressing about my lower levels will be enough to keep me diabetic for sure?  It's a twisted world we live in, and with insurance requirements it's no reason we all go a little crazy.  And right now I'm queen of Looney Land. 

Bariatric Betty's 90 days begins!

I had my first appointment with Drew, a P.A. who has worked with many patients who are planning for bariatric surgery.  He seems to be very knowledgable about everything that I need to do to prepare - both for myself and the insurance company's certification process. 

1) I need to see him 3 more times in the next 90 days or so.
2) I need to keep a food and exercise diary - he suggested myfitnesspal.com and it seems to be pretty user friendly.  Best of all, I can invite my support team to be my "friends" and then they can see how I'm doing each day.
3) I need to see a nutritionist 3 times in the next 90 days to become better educated about how to eat healthy now and after surgery.
4) I need to see a psychologist three times in the next 90 days to help him evaluate me as a candidate for the surgery and help prepare me emotionally for my life post-surgery.
5) I need to work with an exercise physiologist/ trainer who can document my progress with her over the next 90 days, meeting with her at least three times.

At the end of that, he will assemble a packet of everyone's consults and reports plus printouts of my food and exercise diary and send it to Hospital C which will add their parts and send it to my insurance company for pre-certification approval.  Then they can schedule my surgery! 

I'm thinking about sharing this blog with the support team, but I'll probably wait until I know them better :)

I have my first nutrionist and psych appointments in 6 days.  My first surgical consult is in 3 weeks.  My husband is getting me a membership to the gym at his work - Drew knows a trainer there who he said is great at documenting everything we need.  Step by step...

On a positive note, even though I've only lost a couple of pounds, I have been getting complements from people who say that I'm looking like I've lost weight.  It's mostly just improved muscle tone, but I still enjoy the complements!

Bariatric Betty sees the light!

Hospital C's info session was Tuesday.  That's the small catholic hospital that I decided to look at just because of the sticker shock from Hospitals A and B, as well as finding out that they have an excellent reputation for bariatric surgery. 

I am happy to say that I was blown away by Hospital C's presentation!  First, while I had heard that Hospital C was really the first hospital in the area to specialize in bariatric surgery, I had no idea how many they've done.  The surgeon who did the presentation at Hospital A talked about having done hundreds.  This surgeon talked about having done over 3,000!!!  He's going on 3,500.  Their complication rate is exceptionally low.  Their cost for the surgery is at least $16,000 LESS than the other hospitals.  And here was something that nearly made me cry.  They provide a 30-day "insurance" policy for complications from surgery.

What does that mean?  Well, if I had the surgery at Hospital A or B, and then had complications (infection, leaking, excessive bleeding requiring a transfusion, blood clots, etc), then I would be responsible for paying for all of the necessary treatment OUT OF POCKET, because I would already have used my maximum lifetime bariatric surgery benefit, and all complications would be tied to the surgery.  Now they all had lower rates of complications than the national averages, but it's hard not to worry about being the 1 in 100 who had something happen.  Add to that the worry of how much the bills could be (tens of thousands of dollars more) and you get a sense of a little invisible elephant that was sitting on my shoulders.  

At Hospital C, if you have an complications from surgery in the 30 days after the operation, you will be treated AT NO COST.  You won't be billed, your insurance won't be billed.  I hadn't even realized the stress I was feeling about the potential for those bills until it was taken away.  I felt like I had just won the lottery. 

What else impressed me?  The warmth and social aspect of the practice.  They talked about lifetime relationships between the patients and staff.  Having contact information for someone you can call if you have a question 10 years after surgery.  Having not only monthly support groups, but having guest speakers come in.  Having an online chat and website where patients can ask questions and support each other.  Having their annual holiday and summer get togethers with patients and families.  And then there was Graduation.

When you are at least one year post surgery and have been meeting your own goals, you are invited to attend the Graduation party along with your family.  Held in a beautiful hotel it's a evening where all the "graduates" are recognized for their hard work and success, and then everyone parties with a DJ and has fun.  The surgeon invited us all to attend this year's graduation just to be inspired.  Graduation is a an important step, but does not mean you have left the program - it just means that you have done what they told you to do and have begun your new life as a healthier happier person. 

One of the funnier moments of the evening was a question from an attendee who was worried because a friend of her's had experienced a drop in her sex drive after the surgery, and wanted to know if it was common.  In her words "because that is something that I've GOTTA know!"  After sharing a lot of good natured chuckles with the audience, we were reassured that he usually hears the opposite. 

I can't wait to get going.  My personal patient advocate will be calling me in the next week to start scheduling everything, and then my journey will finally start. 

Bariatric Betty and Hospital B

Another week, another information session.  This time it was hospital B, the world-reknown hospital's bariatric center.  Most of the information was similar to what I heard at Hospital A's info session, but the resources given to us were very different.  We got a bound collection of information about the surgeries, possible risks, side effects, outcomes, pre-surgical instructions and diets, post surgical instructions and recipies and diets - basically a really good This-is-what-will-happen resource.  In addition, I got a card from them in the mail saying that I was considered a low risk patient, and only needed to provide them with recent labs, ekg and chest x-ray.  No sleep study required (like it was at hospital A), no stress test (implied that it was required at hospital A), etc.  I also got clued in on something to look for.  Bariatric Centers of Excellence is a national certification indicating high volume, good outcome, low complication rates.  Hospital B is proud to announce that they are one of only two hospitals in the area to be certified.  Hospital A is NOT the other one.  Surprisingly that honor goes to the small catholic hospital C.

Speaking of Hospital C, I also got an amazingly different quote for the cost of the surgery there.  They said that the average cost of the surgeon, facility, and everything except the anesthesia is $24,000!  That's right, at least $16,000 less than the other hospitals. 

That combined with the Bariatric Center of Excellence certification and everything else lead me to decide to cancel my appointment with the surgeon at Hospital A.  I'm considering contacting their patient advocate, PR department, and possibly someone else to make sure that they give accurate information to people who come to their information session from now on.  I spoke to one of their program coordinators yesterday and she still couldn't provide me with how much the average charge would be for the surgeon or anesthesiology.  She also came right out and said that they would only charge a self pay patient $20,000 instead of $40,000 for everything other than the surgeon and anesthesiology.  So if I had done my surgery there, I would have been paying approximately $11,000 and my insurance would have paid $15,000 out of the $40,000 and they would have gotten $7,000 more than with a self pay patient.  I understand the difficulty of self pay patients - we've had to pay out of pocket for speech therapy and other services for my son with special needs before, but why should an insured patient have to pay  $7000 more for the same service?  I was also told that their patients that work at Hospital A end up paying $17,000.  I would imagine that they would get the best deal possible, so I don't have a problem with the $3000 discrepancy between that and the self pay $20,000, but that means just because I have different insurance, they will get $9000 more paid out of my pocket than an employee. 

I contacted my insurance and they are trying to find the allowable amount for the surgery at hospital C, and I scheduled to attend an info session for hospital C next week.  Hospital A is history.  Hospital B and C are still in the running.  Who knew this would be so hard?