About the Program

It is very important that you understand your benefits and any limitation of your insurance coverage. Contact your insurance company and have your current insurance information available. You also have to be aware pf any co-pays that are your responsibility. Our office staff will start the pre-authorization process once you have met program requirements. Check with your insurance company as to what criteria they require for your approval.

You will need to obtain a letter of recommendation and documentation from your primary care physician in order to get approval for your surgery through your insurance company. Check with your insurance company for specific requirements concerning documentation of your medically supervised weight and exercise history. This information must be documented within the past year in the doctor’s chart notes—the insurance companies will not accept a letter simply stating that you have been on a diet. The letter should include a brief medical history, a five-year weight history, and physician-supervised diets followed in the last two years along with the documentation.

Privacy regulations require that you obtain this letter from your family doctor. This must be submitted to the program before the insurance approval process can be started.

This initial consultation with the surgeon can be lengthy as you will need a full assessment by the doctor at this time. During this visit, the doctor will interview you, review your surgical procedure, and answer any questions you may have. The surgeon will also conduct a physical examination. During this appointment, you will be instructed to lose weight (generally 5-10% of your current weight). Your pre-surgical testing may be scheduled at this time, as well as any consultation appointments that the doctor may determine you will need.

An initial consultation with a registered dietitian will assess current eating habits, diet history, medical history, use of vitamins and supplements, and get you started making changes needed for after surgery. If you are not currently on a diet program with your family doctor, our dietitians can help you with a weight-loss plan. The dietitian will schedule follow-up nutrition appointments with you during this time.

A behavioral health consultation with a psychologist is required by insurance companies as well as by the program. This consultation will allow our staff to assess your emotional well-being and your readiness to understand and follow the requirements before and after surgery.

If you have an orthopaedic condition or other medical conditions, you may be required to obtain a physical therapy consultation. Some insurance companies require you to submit documentation of your participation in an exercise program. The physical therapist will complete an assessment and develop an exercise program for you to follow based on your physical abilities.

If you are required to see additional physicians/specialists, you will need medical clearances from them before you can have surgery. The following are examples of what you will need if these additional visits are ordered:

• Pulmonary- If you have history of asthma or other breathing difficulties, you will need to see a lung specialist. Based on the evaluation results, the lung specialist may be involved in your care during your hospitalization to monitor your respiratory status preoperatively.

• Sleep Study- Your medical history may indicate that you will need to complete a sleep study to assess your ability to breathe while you are sleeping and to determine if a CPAP machine is needed to aid in your breathing. If a CPAP is required, you will need to be using this machine anywhere from two to four weeks prior to your scheduled surgery. The CPAP must also accompany you to the hospital for preoperative use.

• Cardiology- Patients who have a cardiac history, high blood pressure, or an abnormal EKG will need clearance from a cardiologist. Patients who are over 50 years of age or whose BMI is over 50 will require cardiology clearance as well.

• IVC Filter- An IVC filter is a device that is surgically implanted to prevent blood clots from traveling from your legs to your heart and lungs. If you have a history of blood clots or it is determined that you may be high risk for these, you will be scheduled for an appointment with a vascular surgeon and the procedure will be scheduled. The filter should be placed one to two weeks prior to your surgery.

• Other- Individual health history and present circumstances may require patients to have additional tests or clearances from other physicians/specialists. This is determined by the surgeon at your consultation appointment.

After you have completed all requirements of the weight-loss program and have been approved by our bariatric review committee, a surgical date will be chosen. Subsequently, a pre-authorization request letter will be submitted to your insurance company to determine benefit coverage. This is a lengthy process and can take up to 8 weeks. Our staff will keep you informed of the progress and will let you know when a determination is reached. If you are denied, it will be up to you to file an appeal with your insurance company. 

This appointment with the surgical office is scheduled about 2-4 weeks prior to your scheduled surgery. At this appointment, your chart will be reviewed to determine that you have completed all necessary steps and to verify that the specialists you’ve seen have cleared you for surgery. We will answer any additional questions you have, prescribe medications you will need postoperatively and have you sign your surgical consent, informed consent and blood transfusion consent forms.

Our surgeon or gastroenterologist performs all of the endoscopy procedures on our surgical candidates. This procedure is to determine if you have any problems that may need to be treated prior to surgery. This test involves the insertion of a tube down your throat into your stomach and the first part of the small intestine and is usually performed one month prior to your surgery.