The Weight Loss Surgery Center
16 Hospital Road
Plymouth, NH 03264
Phone: 603-536-5670
FAX: 603-536-1544
Pre-Operative Patient Packet
If you have questions, please contact:
Jamie Mills, RN, BSN
Nurse Coordinator for Plymouth General Surgery
a department of Speare Memorial Hospital
16 Hospital Road
Plymouth, NH 03264
The Weight Loss Surgery Center 16 Hospital Road Plymouth, NH 03264 603-536-5670 FAX: 603-536-1544 Welcome to the Weight Loss Surgery Center (WLSC) at Plymouth General Surgery and Speare Memorial Hospital. The WLSC is a coordinated effort by Speare Memorial Hospital to provide patients with access to metabolic and bariatric surgery. We strive to prolong life by helping to control medical conditions that result from obesity through surgical intervention, education, behavioral modification and lifelong support for our patients.
The WLSC team looks forward to working with you and getting to know you better throughout your journey to
wellbeing. We use a multidisciplinary approach and utilize bariatric surgeons, primary care providers, nurses, dietitians, exercise physiologists and behavior health specialists to help determine how to create the best and safest outcomes for our patients. We also work closely with specialists and our WLSC staff will refer patients to other providers when deemed necessary.
Weight management is a lifelong journey and we believe that in order to be successful, you must agree and commit to changes in lifestyle and behavior both before and after weight loss surgery. These modifications are imperative to long-term success with weight loss, regardless of the approach. Throughout your time with us we hope to educate and inspire positive change that encourages you to become dedicated to your lifelong health and wellness ambitions.
Thank you for attending the information session regarding weight loss surgery. Enclosed you will find forms and steps that will need to be completed, prior to consulting for weight loss surgery with one of our surgeons. Towards the end of the packet you will see a patient checklist. This checklist will be very helpful when organizing documents and scheduling necessary appointments pertaining to weight loss surgical clearance. Please note the patient contract, found in the pre-operative packet. We ask that our patients sign this contract, along with the practitioners that will be involved in their care, verifying a mutual understanding of what will be required to ensure the best surgical outcomes possible for our patients. The pre-operative packet will be reviewed in detail prior to signing the patient contract, at the time of consult. Please be sure to contact our office with any questions as you begin to navigate the program and obtain the documents necessary for weight loss surgery clearance. Also, please remember that everyone has a different journey through the weight loss surgery process and please expect a minimum of five to six months in our program prior to weight loss surgery. We are here to help guide you and to ensure that patients receive the best and safest care possible.
Sincerely,
James P. Koren, M.D, Weight Loss Surgery Center Director
Jamie Mills, RN, BSN, Weight Loss Surgery Center Program Coordinator Janette Gaumer, RD, LD, Weight Loss Surgery Center Registered Dietitian Robert J. Chastanet, M.D, Weight Loss Surgery Center Bariatric Surgeon Weight Loss Surgery Center at Plymouth General Surgery
Helpful Information for Patients Entering the Weight Loss Surgery Center
INSURANCE ISSUES: Please pay CAREFUL and THOROUGH attention to the instructions provided by your insurance company in regards to weight loss surgery approval. Ask your insurance provider to mail the policy pertaining to weight loss surgery to your home address; also ask that they provide a copy to you via email. Patients of The Weight Loss Surgery Center will need to have a copy of their specific policy on hand and will ultimately be
responsible for knowing what their insurance requires of them, for weight loss surgery approval It is imperative that you call your insurance company and confirm that weight loss surgery is
covered under your SPECIFIC policy. Some insurance companies have general guidelines for weight loss surgery; however, the individual policies may differ within the same insurance company
The two surgeries offered at The Weight Loss Surgery Center are listed below; patients may need to specify the specific surgery being performed when discussing benefits with the insurance provider. The billing codes for the surgeries offered are provided bellow as well: 1) Roux-en-Y Gastric Bypass (43644)
2) Sleeve Gastrectomy (43775)
The above procedures are performed laparoscopically; however, when submitting for approval to insurance companies, The Weight Loss Surgery Center may include the “open” surgical procedure code as well in case it is deemed necessary at the time of surgery
REFERRAL & MEDICAL INFORMATION THAT WILL NEED TO BE OBTAINED:
Prior to meeting with the Weight Loss Surgery Center (WLSC) program coordinator and surgeon, we ask that you please obtain a referral from your primary care physician (PCP) and a copy of the latest history and physical (within the last 6 months). With these records, please include any labs and testing that have been performed in the last 6 months
If you have not seen your PCP in the last 6 months, please send the records that you do have and make an appointment with your PCP ASAP to obtain a referral for weight loss surgery
Labs that are REQUIRED, and may need to be REPEATED PRIOR TO SURGERY:
Type and screen
Hgb A1C
CBC
CMP
B12+Folate
Pregnancy test day of
surgery
TSH
Vitamin D
Fasting lipid panel
H-pylori
Iron/Ferritin/TIBC
Nicotine test (if hx of
smoking)
Depending on your surgeon’s preference, other labs may be required and ordered throughout the program Please check with your insurance company regarding coverage, prior to any testing. Patients are
Examples of testing that MIGHT BE NEEDED, depending on insurance requirements, medical history and your weight loss surgeon’s preference:
The WLSC team may need to contact your PCP (or other providers you have seen in the past) to obtain additional information, not previously mentioned, on your behalf for weight loss surgery clearance. In addition to obtaining your records, please fill out the RECORDS REQUEST FORM provided in the health history packet and return it to the Weight Loss Surgery Center at your earliest convenience
Please fill out the INSURANCE VERIFICATION FORM provided in the health history packet and return to the Weight Loss Surgery Center at your earliest convenience
Please complete the HEALTH HISTORY PACKET in its entirety and return it to the Weight Loss Surgery Center at your earliest convenience
Be thorough and specific when filling out the Health History Packet, as it is ALL pertinent to the surgical clearance process. There may be certain diagnoses, etc. that require the WLSC team to obtain further records, order further testing or change the screening process to suit the needs for patients as individuals and ensure for the best and safest possible patient outcomes. In these circumstances, you will be
contacted by the Nurse Coordinator regarding the next steps needed in the WLS process
If you have ever been diagnosed with sleep apnea, you will need to follow up with your sleep study physician and the WLSC will ask for a compliance report from your CPAP
If there is a possibility of undiagnosed sleep apnea, the WLSC recommends that patients obtain a referral from their PCP for sleep medicine. Patients are encouraged to schedule their appointment with sleep medicine ASAP so it does not hold up the surgical process
Formal referral from your primary care provider (PCPs generally will have a template they use for referrals) Please obtain a LETTER OF RECOMMENDATION FROM YOUR PCP and send a copy along with the other
required documents. The letter needs to state the following:
PCP believes that you are a good and appropriate candidate for weight loss surgery
You have previous, and witnessed failed attempts at weight loss through medical management Specifics regarding attempts in the past; i.e. Weight Watchers, dietician referrals, attempted exercise
regimens, any physician or dietician led program, etc.
Many insurance companies require documentation in your medical records by a provider (PCP), in regards to the past failed attempts. When speaking with your insurance company, please ask if this is required for your specific policy
Echocardiogram
Chest x-ray
Pulmonary function testing
Sleep study
Upper endoscopy or
colonoscopy
Additional meetings with
dietitian, behavior health
specialist and/or other
providers
EKG
Any lab work
Evaluations by specialist
(cardiologist, pulmonologist,
etc.)
Behavioral health records
Blood work completed within
the last 6 months
The Weight Loss Surgery Center
16 Hospital Road
Plymouth, NH 03264
Phone: 603-536-5670
FAX: 603-536-1544
The Weight Loss Surgery Center Program Helpful Patient Information:
How does the WLSC determine if a patient qualifies as obese? Our program determines obesity by Body Mass Index (BMI):
Adult BMI ranges:
Underweight:
<18.5
Normal or healthy weight: 18.5-24.9
Overweight
25.0-29.9
Class 1 Obesity:
30.34.9
Class 2 Obesity:
35-39.9
Class 3 or Morbid Obesity: 40 and above
How does the WLSC calculate a patients BMI?
Devised in the 1830’s by a mathematician the formula for calculating your BMI is as follows: Imperial:
BMI= 703 x weight (in lbs) ÷ (height in inches)2
Metric:
BMI= weight (in kg) ÷ (height in meters)2
What causes morbid obesity and why is it harmful?
About 3-5% of the population in the USA is classified as having severe or morbid obesity; this can be defined as being 100 lbs (45.58 kg) overweight or 100% above the ideal body weight for an
individual, with a BMI ≥40
Morbid obesity has been associated with patients developing many life threatening conditions and some of these conditions include: hypertension, sleep apnea, diabetes, heart disease, and mental illnesses
There are endless possible causes for morbid obesity, and it appears that the root cause is poorly understood. A few factors that have shown to contribute to whether or not an individual will become morbidly obese include: genetics, environmental factors, socioeconomic status, cultural influences and psychological predispositions
Weight Loss Surgery Options Offered at Speare Memorial Hospital Roux-en-Y Gastric Bypass:
This procedure is considered the “gold standard” for significant, long-term weight loss in clinically obese patients. This procedure will restrict the amount of food a patient will be able to eat and will also change the way in which food is absorbed in the digestive tract
This type of weight loss surgery involves the creation of a small gastric pouch (reducing the size of a patient’s stomach); this pouch is then connected directly to the small intestine
Gastric Sleeve (Sleeve Gastrectomy):
Was initially offered in the severely obese patient population as a first line approach for surgical weight loss
This approach will remove a large portion of the stomach, leaving a banana shaped section that is closed using a stapling technique
The gastric sleeve reduces the amount of food that is able to fit into your stomach, which in turn will make you feel fuller with less food being consumed. This approach is also known to change the hormones and bacteria found in the gut which has been shown to affect metabolism and appetite in patients
Which is the better surgery?
Gastric bypass has a longer proven “track record” by combining restriction of eating with a small component of malabsorption (decreased ability to absorb nutrients)
Sleeve gastrectomy has less alteration to the anatomy. It restricts the amount that can be eaten at once, but has no component of malabsorption
Individual differences may lead to a strong suggestion by our surgeons of one vs. the other As previously mentioned, both of the weight loss surgeries offered at the WLSC are done laparoscopically; however, in some instances an “open” approach may be necessary.
In what instances would weight loss surgery need to be performed through an open approach, instead of laparoscopically?
Bariatric surgery is now commonly and preferably performed laparoscopically; however, in certain instances a surgeon may need to elect to convert to the open procedure. Reasons such as bleeding or an inability to visualize are potential causes for a surgeon to convert to the open approach. This decision may be made either preoperatively or during the procedure and is purely based on the safety need of the patient
What are the expected postoperative results for weight loss surgery?
Gastric bypass (Roux-en-Y Gastric Bypass): weight loss averages approx. 30% of total weight over a 5 year period
Sleeve gastrectomy: patients weight loss averages approx. 25% of total weight over the same 5 year time frame when compared to the Roux-en-Y
The majority of scientific medical data shows that weight loss surgery can improve or cause remission of many medical problems such as hypertension, diabetes, obstructive sleep apnea, high cholesterol, infertility, gastroesophageal reflux (GERD), arthritis, chronic headaches, venous stasis disease, liver disease and heart failure (although there is no specific guarantee)
How do these surgical weight loss statistics differ from nonsurgical weight loss techniques?
Diet and Exercise: a weight loss of 10% of overall weight was found to be successful (i.e. maintained for over a year) in 20% of people
With this approach success is achieved best when incorporating the following Diet 7 days a week
Exercise for 30-60 minutes; 5-7 days a week
Weigh yourself daily to catch weight gain early and change behavior as soon as possible What are the risks associated with weight loss surgery?
Research shows that nationally approximately 93% of patients report no complications postoperatively within the first 30 days after surgery
Weight-loss surgery, as with any major surgery, has risks. Although surgical complications are rare, it is important for you to fully understand any potential risks so you can make an informed decision about whether or not to have the surgery
Your WLSC team will use their expertise and knowledge to avoid complications, and if a problem does occur, they will use those same skills to attempt to solve the problem quickly
Although uncommon, some complications can involve an extended hospital stay and recovery period
It is important to know that weight loss surgery cannot be completely reversed. The decision to have this procedure must be made in consultation with your surgeon and a very careful consideration of the potential benefits and risks and lifelong consequences
Potential complications of weight loss surgery include, but are not limited to: Infection, bleeding, or leaking at stiches/staple lines
Blockage of intestines or stomach pouch Dehydration
Blood clots in the legs or lungs Vitamin and/or mineral deficiency Protein malnutrition
Incisional hernia
Cannot reverse, or difficulty reversing Revision procedure(s) sometimes needed Death
You will be instructed to refrain from drinking alcohol for a minimum of 6 months post-operatively Due to the risk of bleeding and developing ulcers you will need to refrain from using Aspirin,
Patient Criteria for Weight Loss Surgery at Speare Memorial Hospital
Minimum criteria and expectations to be eligible for weight loss surgery at the Weight Loss Surgery Center: The criteria mentioned below is an outline. The WLSC clinicians and surgeons reserve the right to refuse surgery to anyone, whom they do not feel is appropriate for weight loss surgery
1. Adult between the ages of 18 and 64
2. BMI of 40 or greater, as this represents being roughly 100 lbs overweight and defines morbid obesity
3. Females with a BMI of 40-60 4. Males with a BMI of 40-55
5. Females or Males with a BMI of 35-40 with a diagnosis of comorbidities such as Type II Diabetes Mellitus, Hypertension, Cardiovascular Disease, Obstructive Sleep Apnea
6. Patients without organ failure (e.g. severe CHF, end stage renal disease, severe liver disease, and organ transplant or significant cardiac or pulmonary impairment)
7. Must not be a candidate on a transplant list 8. Must be able to ambulate
9. Patient must understand that surgery is not a cure for obesity; it is a tool to help patient better control their intake of food and build new eating patterns
10. Documented failed attempts using non-surgical weight loss methods (this needs to come from your PCP, or other weight loss specialist/medical professional and we must have attempt in a documented and recorded letter or office visit notes)
11. ALL clinicians actively involved with the patient at the WLSC must be in agreement and approve of appropriateness for patient to undergo weight loss surgery
12. Commitment to life-long dietary changes and follow-ups
13. Ability and willingness to use birth control for one year after surgery (females of childbearing age) 14. Smoking cessation (must be nicotine free for a minimum of 3 months prior to surgery; you will have
a nicotine test preoperatively) 15. Attend an information session
16. Complete application form, sign medical release form and mail/or drop off to our office address as discussed above
17. Attend all scheduled meetings with dietician, surgeon and bariatric coordinator
18. Clearance for weight loss surgery by Registered Dietitian proficient in the weight loss surgery 19. Complete behavioral health evaluations and be cleared by behavioral specialist with knowledge in
bariatrics. The WLSC clinicians must have access to this individual and be able to discuss care with specialist
20. Compliance and active participation with our programs’ instructions, appointments, and assignments
21. Patient must take an active role in their success
22. If using insurance, patient must meet all needs put forth by their individual insurance plan and policy. It is the responsibility of the patient to know what their insurance company is to expect of them
Exclusions to entering the Weight Loss Surgery Center and possible disqualifications for surgery
Surgery may be delayed or cancelled for any patient who does not meet the WLSC program requirements or who fails to follow through with instructions. Other possible exclusions are as follows:
1. BMI outside of acceptable range for the WLSC (<35, ≤40 without approved comorbidities, >55 for males or >60 for females)
2. Age: Over 65 years or under 18 years 3. Failure to attend information session
4. Failure to comply with diet assignment (i.e. necessary preoperative behavioral modifications, failure to track appropriately)
5. Failure to quit smoking 3 months prior to surgical date Labs for nicotine will be checked prior to surgery
6. Medial or psychiatric condition or history contraindicating surgery, or found to be an inappropriate candidate by behavioral health expert (this may occur even without psychiatric history)
7. Active substance abuse and in some instances recent abuse will also disqualify a patient (this includes nicotine)
8. Inability to commit to the life-long dietary restrictions created by metabolic and bariatric surgery; which includes the inability to adhere to the changes required preoperatively
9. History of previous weight loss surgery 10. History of previous Nissen Fundoplication 11. Failure to have the ability to ambulate 12. Need for or history of an organ transplant 13. Significant cardiac or pulmonary impairment
14. WLSC has a 3 strike policy in regards to missing appointments. 3 missed appointments without
calling or emailing to cancel to your appointment will result in exclusion from the WLS program. Cancellation after the scheduled appointment time will not be acceptable, and will count as a strike. Lateness to appointments may be included in the 3 strike policy; at the discretion of the provider or clinician patient is scheduled to see. One missed appointment that meets the above criteria will reset your progress in the program (i.e. missing the third nutrition visit will
automatically reset you to nutrition visit one.)
15. Insurance plan or policy that does not approve for patient to have surgery. Again, it is the
responsibility of the patient to know their insurance policy and what will be asked of them in order to be approved for surgery.
16. The clinicians, surgeons and providers determine a patient is not appropriate for weight loss surgery, for any reason
17. Desire to become pregnant within 18 months of surgery
18. Patients that are not able to accept the potential risks and complications associated with weight loss surgery
Support Groups:
Support Groups will occur monthly, on the first Thursday of every month 4:30pm-5:30pm
They will be held in the community room at Boulder Point (same location as information session)
These meetings are not mandatory; however, they are greatly encouraged and have been shown to provide patients with better surgical outcomes
The Weight Loss Surgery Center Attn: WLSC Coordinator 16 Hospital Road Plymouth, NH 03264 Phone: 603-536-5670 FAX: 603-536-1544
Detailed Pre-Operative Requirements
1) Attend a weight loss surgery information session held by the Weight Loss Surgery Center
☐
o Seminars are offered monthly and are generally held on the second Thursday of every month at 5pm. Please see our website for current dates, times and locations. Pre-registration is required and you may register by visiting our website or by calling our office:
Weight Loss Surgery Center website and phone number:
https://spearehospital.com/weightloss/ 603-536-5670
o At the seminar you will meet one of the surgeons on our bariatric surgery team, the bariatric program nurse coordinator and a registered dietitian representative. You will learn about the surgical weight loss options available at our center, the benefits and risks of each surgery and gain more knowledge in regards to our program requirements. You will also have a chance to ask our weight loss surgery team questions you may have about the program.
2) Please fill out the forms provided in their entirety and fax, mail or drop off to the WLSC
☐
You may also fill out the forms and hand them into the bariatric nurse coordinator at the end of the information session, if able to do so
o Please provide the WLSC with the following, as explained in detail above: Records request form
Insurance verification form Health history packet
3) Obtain the following documents from your primary care provider and turn into the Weight Loss Surgery
Center as described in step 2 ☐
o Records to obtain: make 2 copies 1 for WLSC and 1 for your keeping. It is highly encouraged that
you keep a copy of EVERY document, record, letter, etc. that is obtained throughout the program and that you place it in your patient binder that will be provided to you
All pertinent records as described above Labs, testing, etc.
Referral from PCP
Letter of recommendation from PCP
4) Call your insurance company
☐
o It is the responsibility of the patient to know what their insurance requires of them for weight loss surgery approval at the WLSC
Call the insurance company to discuss weight loss surgery benefits and make sure that they are active
Make a list of required steps for surgery approval discussed with insurance agent
Ask that your insurance company mail and email you a copy of your specific policy in regards to weight loss surgery, and place it in your patient binder (when you get it)
Some insurance companies have different requirements as they pertain to specific policies (especially employee based plans). When discussing weight loss surgery with your insurance company, ask them to be certain they are discussing your specific policy as coverage may differ for two patients under the same insurance carrier based on the policy specific to that patient
Ask the next time your policy will be up for review. If it is in the next year be sure to contact the insurance company at time of review in case changes were made to the weight loss surgery specific policy
ALWAYS record name and reference number of insurance agent you speak with for your records
5) Once patient records are obtained, the WLSC will review health history and will then contact you regarding
your next steps to take
☐
o Once the WLSC has received pertinent records and a referral from your PCP, the WLSC team will meet to discuss patient history, etc. and decide as a team, the appropriate next steps for the patient to take
o The WLSC nurse coordinator will contact you to discuss next steps to take on your weight loss journey
o If it is determined that the patient is not eligible for surgery at the WLSC or if more information is needed prior to continuing with the program, the bariatric nurse coordinator will call you to discuss next steps to take
At this time, if it is determined by the WLSC team that the next appropriate step is for you to move forward with the program, then the following steps will occur
6) Schedule an appointment with the bariatric nurse coordinator, prior to consultation with the surgeon and
review the following ☐
o Read and sign the enclosed patient outline and contract, agreeing to the terms of the WLSC preoperative program
o Receive your patient handbook (binder) and review with the nurse coordinator
You will be required to carry the patient binder with you at all times and add important documents, records, etc. to the binder as you obtain them
o Discuss questions you may have at this time
o Review history that was discussed with the WLSC team and possible necessary steps o Review insurance requirements and policy obtained by patient
o Please bring a list of current medications to this appointment to review with RN
7) Consultation with a WLSC surgeon
☐
o Review your health history o Conduct a physical exam
o Begin discussing necessary lab work and testing that may need to be done preoperatively o Obtain referral to RehabFit or other necessary referrals
o Order preoperative labs and have them drawn
8) Begin an exercise routine
☐
o You are encouraged to begin and maintain an exercise routine throughout your journey towards weight loss
o If you do not already exercise regularly, please check with your primary care provider before beginning any exercise routine
o Exercise is greatly encouraged prior to and after weight loss surgery. Some insurance companies require documented exercise compliance over a specific period of time prior to weight loss surgery approval. Please check with your insurance company regarding your specific policy requirements o To better assist patients with starting a safe exercise routine and in order to obtain documentation
for insurance purposes, the WLSC has partnered with RehabFit:
RehabFit Information
Address: 103 Boulder Point Dr, Plymouth, NH 03264
Phone: (603) 238-2225
Website: https://spearehospital.com/tag/rehabfit/
$21/month with referral from the WLSC
Meet with an exercise specialist and develop a plan to safely meet your exercise
needs
Obtain documentation that may be needed to send to insurance for weight loss
surgery
Begin lifestyle changes now for better outcomes postoperatively
The order that the behavioral health clearance and the nutrition clearance are obtained in, will depend on the
individual patient needs and scheduling. The timeframes mentioned below may differ from patient to patient and will depend on many individual factors
9) Dietitian meetings and clearance from Registered Dietitian for weight loss surgery
☐
o You will be required to have an initial consultation as well as ongoing monthly visits with our dietitian throughout your journey to weight loss surgery (bariatric visits with Registered Dietitian may not begin prior to consultation with surgeon)
o These meetings will require a minimum of 6 consecutive monthly visits (minimum 180 days duration) which may require you to pay out of pocket for visits, depending on your insurance policy
This time frame is necessary for appropriate behavioral changes and adequate assessment of anticipated postoperative dietary maintenance
This is the gold standard in regards to dietary preoperative counseling
Your initial assessment meeting with our Registered Dietitian may not be included in the minimum visit requirements
Your health and wellness is our priority. This part of the journey takes the most discipline, and in order for you to experience the best outcomes be prepared to make positive behavioral changes over these visits
o The WLSC team will need to see that the patient is able to adhere to changes that will be necessary postoperatively to ensure long term success with weight loss surgery (i.e. it will be necessary to track diet and behavioral changes throughout the program, patients will be required to show
o The number of visits needed prior to being cleared for surgery is at the discretion of the dietitian and might also depend on insurance requirements.
o You may need to pay out of pocket for dietitian appointments, if the number of necessary appointments for surgery clearance (by the WLSC) is not covered by your insurance
o The dietitians contact information will be provided to you at your meeting with the bariatric nurse coordinator
o Once cleared by nutrition, you will need to follow up with the dietitian at least every 30 days
10) Behavioral Health evaluation and clearance
☐
o You will be required to have a behavioral health evaluation as part of the clearance process for weight loss surgery
o The behavioral health professional must have experience providing pre-bariatric surgery
evaluations and the WLSC team will need to be in open discussion and in contact with the
behavioral health professional providing evaluation and clearance
o This evaluation is often completed in a MINIMUM of two visits and the visits are generally 30 days apart
o We work closely with behavioral health professionals in the Plymouth, NH area that are familiar with the weight loss surgery process; their contact information will be provided to you at your meeting with the bariatric nurse coordinator
o You may need to pay out of pocket for these appointments, if the number of necessary appointments for surgery clearance (by the WLSC) is not covered by your insurance
When the above steps are completed and you have been cleared for surgery by all necessary practitioners (the WLSC team must also be in agreement that the candidate is appropriate and ready for surgery at the WLSC. It is possible for a patient to be deemed cleared by the dietitian and/or behavioral health but not found to be an appropriate
candidate for surgery by the WLSC team), you will continue with the steps listed below
11) Preoperative appointment with your weight loss surgeon
☐
o Within 30 days of scheduled surgery you will meet with your weight loss surgeon again to: Sign consent
Review risks, benefits and description of procedure to be performed Touch base on questions, concerns, etc.
Order remaining labs, testing, etc.
Schedule postoperative follow ups with surgeon
12) Insurance prior authorization process
☐
o Nurse coordinator will gather all pertinent records and information and will send them on your behalf to your insurance company and obtain prior authorization for surgery
o There may be further evaluations, etc. that the insurance company requests and we therefore,
ALWAYS ALLOW AT LEAST 30 DAYS for completion of the insurance prior authorization process
o If your insurance company requests more information, testing, etc. the nurse coordinator will contact you to discuss next steps
o You will be notified as soon as approval has been obtained
13) Preoperative appointment with anesthesia, operating room team, and final preoperative visits with the
bariatric nurse coordinator and the registered dietitian
☐
o At this time anesthesia may request further testing to be done prior to surgery to ensure patient safety (ex. EKG, PFT’s, labs, etc.)
1. Attend a weight loss surgery information session held by the Weight Loss Surgery Center ☐
2. Fax, mail or drop off the following COMPLETED documents to the WLSC team at your
earliest convenience ☐
o Records request form ☐
o Insurance verification form ☐
o Health history questionnaire ☐
3. Obtain and turn in the following to the WLSC with the requested documents mentioned in
step 2 ☐
o All pertinent records as described in detail previously ☐
o Labs, testing, etc. ☐
o Referral from PCP ☐
o Letter of recommendation from PCP ☐
4. Call your insurance company, verify benefits and retain copy of your specific patient policy
as it pertains to weight loss surgery at Speare Memorial Hospital ☐
5. Wait for a call from the bariatric nurse coordinator regarding next steps to take ☐
6. If you are eligible for the WLSC program, schedule an appointment to meet with the
bariatric nurse coordinator ☐
7. Schedule a consult with a WLSC surgeon ☐
8. Obtain labs and necessary preoperative testing/clearances from specialists, etc. ☐
9. Begin an exercise routine ☐
10. Dietitian meetings and clearance from Registered Dietician for weight loss surgery, must
consult with surgeon prior to dietitian meetings ☐
11. Behavioral Health evaluations and clearance ☐
12. Preoperative appointment with your weight loss surgeon, schedule date for surgery ☐
13. Obtain insurance prior authorization ☐
14. Preoperative appointment with anesthesia, operating room team, and final preoperative
visits with the bariatric nurse coordinator and the Registered Dietician ☐
15. Surgery ☐
All insurance companies and patient polices are different and most have specific requirements that must be met prior to your insurance giving you a prior-authorization for bariatric surgery. Please contact your insurance company to find out what your plans specific policy benefits and requirements are.
1. Call your customer service number listed on the back of your card
2. Advise the representative that you are calling to check benefits for weight loss surgery for obesity 3. Follow the questions below and write down the answers given to you by the representative 4. If you have a primary and a secondary insurance please call both insurance companies
5. When speaking with your insurance company always record and save the reference number for the call and the name of the representative you spoke with
Questions for insurance company:
1. Does my specific policy have weight loss surgery coverage?
2. Does my policy cover gastric sleeve operations and gastric bypass surgery for the treatment of obesity? 3. Could you please mail me a copy of my specific policy in regards to weight loss or bariatric surgery? 4. If your policy does allow benefits for bariatric surgery, ask the next set of questions?
a. What is the minimum BMI for coverage? b. Are there comorbidity requirements?
c. Does my policy cover Laparoscopic gastric sleeve – CPT 43775
d. Does my policy cover Laparoscopic Roux-en-Y gastric bypass – CPT 43644
e. Do I need to complete a medically supervised weight management program with a Registered Dietitian before surgery is authorized by my insurance (regardless this is a requirement of the WLSC program)?
o How many visits are required by insurance, how many are covered?
I may need more visits that what is covered by insurance, how much will this cost? Do the visits need to be in consecutive months? Over a certain amount of days? Is there a time period that these visits need to be completed in?
5. Does my plan require a behavioral health evaluation (regardless this is a requirement of the WLSC program)? o If so how many sessions and within what time period is required?
6. Does my plan have any other requirements for prior authorization? 7. Can you provide me with documentation of these requirements? 8. Does my policy include coverage for anesthesia?
9. Is Speare Memorial Hospital in my network for bariatric surgery? 10. Is (my surgeons name) in my network as a surgeon for bariatric surgery?
11. Does my policy cover services needed for surgical clearances like dietitian, mental health, specialty visits, visits to and pre-admission testing?
Disclaimer: Speare Memorial Hospital and Weight Loss Center at Plymouth General Surgery are not responsible for incorrect information provided by the insurance company.
