Health Insurance and Finding a Surgeon

I've had a lot of health issues in the last ten years, not only the ones already mentioned but also depression, insomnia, migraines, unspecificied stomach issues, and a lot more. As the song says, I'm much too young to feel this damn old. I've gotten used to calling doctors and insurance companies, saving copies of things, filing appeals and the like. My advice is: document, document, document. Save everything until you have the statement showing $0.00 in your hand, then have a shredding party.

I haven't been working full-time for a couple of months, so I am dealing with my spouse's insurance on this procedure. They were taken aback to find out they were my primary insurance, so that had to be verified recently. Then they told me the only bariatric surgery provider they covered was over 50 miles away. I watched a web seminar on his site and went to the initial appointment, thinking his practice was my only option unless I was going to self-pay.

Well, I didn't like the doctor. He wasn't listening at all, he didn't bother looking at my medical records, and he was ready to run a bunch of tests I'd had in the last couple of years when the results were present in the medical records he wasn't looking at. He was extremely dismissive. In effect, he said, "We do the surgery, we make you sick if you eat ice cream, you get thin, end of story. Bye bye." That approach did not do it for me.

I had recently read about another facility in the newspaper who had gotten some positive attention for their standards in minimally invasive and cutting edge weight-loss surgeries. They happened to be more conveniently located. My husband and I went to their free seminar, and it was fantastic. It was interactive, informative...I took pages of notes and was ready to sign anything and go to work for them, too, if they'd let me. The bedside manner of the doctors was like night and day from the previous surgeon. This particular facility emphasizes nutritional classes, follow-up care, nutritional coaching, support groups if you choose to participate in them, etc. I was really excited by their approach, because it actually sounds like it can work. They gave us information on how to finance surgery if insurance would not pay and that was that. Imagine my surprise when they told me they were a contracted provider with my husband's insurance! Glad I asked!

I then went to retrieve my medical records from the first bariatric surgeon--there were about 600 pages of them, so I was grateful not to have to accrue them all again. It also made it much easier to fill out the new facility's application accurately--they want every bit of medical history and then some. My intake appointment, as they call it, involved meeting with a lady who does billing and is the liaison with the insurance, and then a consultation with the surgeon. A lot of it was review from the seminar and other research I've done.

The surgeon I met with recommended gastric bypass for me because I have "what they call" classic metabolic syndrome, where I gain all my weight in the torso, also known as the apple body type or, as I once heard it explained, "egg on stilts look." (Apparently, there is a connection between which bariatric surgery might achieve optimum results for each specific body type.) I asked him if PCOS was still present when there were no longer ovaries, and he said, "That's a really great question!" I don't know if anyone knows that answer.

My particular insurance wants 6 months of a physician-supervised diet, two years of chart notes at a certain weight and BMI, the psych eval, the nutritional assessment, and a monthly visit to check in with the nutritionist. There are nutrition classes prior to surgery and after it.

Another thing I like about this facility is that they call the providers to find out what your benefits are initially, instead of you doing that. It sets a precedent with insurance, and a good one--insurance is always going to be more attentive to the provider. Still, you have to be loud if you want anyone to listen to you at ALL. Loud, persistent, with your headache cure of choice at the ready.

Oh, doctors

I am really picky about doctors. I love the joke about the only difference between God and a doctor (God doesn't think he's a doctor). I've "fired" a lot of doctors over the past ten years--most of my life, I didn't have health insurance, so I guess I am just drunk with power. Seriously, if a doctor doesn't listen, I'm gone. But if a doctor is great, I will recommend him or her to everyone I know. I drive three hours one way to stay with a primary care provider I've had for ten years, because she is the best doctor I've ever had, bar none. And who knows how many referrals I've given her--I've lost count!

I remember being a kid on medical coupons, sitting in the waiting room for hours until they got good and ready to see me, even if I had an appointment. That tends to give a person an attitude to begin with (not that I have any shortage of it). I'm sure they still do that every day to poor people, and it makes me furious, but if I start talking about what's wrong with the health care system as a whole, I could be here all day.

A watershed moment for me was when I was sitting on a doctor's table with a broken ankle at the age of sixteen. The bone had not yet been set, and I weighed a great deal less than I do as I write this. This doctor looked at me and told me I needed to lose weight. I snarled as if possessed, "Why don't you set my broken bone first and then we'll talk?" That was the end of my passivity with medical professionals of any stripe.

Let's see. There was the doctor who insisted on giving me a pregnancy test before I was even sexually active, which was highly embarrassing for a kid, but in the shadow of the aforementioned 3 cup sizes in a summer, reason left a lot of people I encountered--male and female. There was the urgent care clinic doctor who griped at me about my weight even though I was just trying to get antibiotics for strep throat and go home. Even my favorite doctor popped off once, saying only "you need to lose weight" before she looked at my chart--I had lost 40 pounds since the previous visit, and I wasn't quiet about it. She never did it again. She has never shined me on about my weight and the problems it can and has caused, but we discuss it like rational human beings. She knows I'm intelligent, I know she's intelligent, there's a two-way street there. (Too many doctors act like you've never looked in a mirror and they are giving you some brand-new insight into yourself, as if a light shone down from above and the angels sang: AAHHHHHHHHHHHHHHH!! You are fat!!! Light bulb!!!!!)

So my favorite doctor recommended gastric-bypass surgery for me when I first started seeing her. I couldn't afford it, and that was my reason for a long time. I had a good job with excellent insurance when I had to have my hysterectomy five years ago, and she suggested I have gastric-bypass surgery done at the same time. I refused; I was just dealing with too much at once, and in retrospect, I still stand by that decision. The recovery from a full abdominal hysterectomy was so long and so difficult for me, even at the young age of 32. I was home for six weeks, and didn't have any stamina at all for about a year. At first, I had to take a nap after walking to the mailbox, I was just so tired.

I knew weight-loss surgery was no walk in the park. I was never going to have gastric-bypass surgery; there were so, so many horror stories. I remember reading once back then that you had a 1 in 4 chance of dying during surgery and a 1 in 4 chance of dying within a year of surgery. I probably misunderstood those numbers (not good odds!), but they scared the stuffing out of me. I knew people that had done the stomach-stapling surgery when I was a kid who had had all kinds of complications. Even five years ago, my understanding was still that they would have to cut you completely open, which is why my doctor suggested that I have it at the same time as the other procedure.

Last year, I had an initial consultation with a sleep doctor who had that tactful technique of so many health professionals I cited above; before we talked about anything else, he blurted out, "You would be a candidate for bariatric surgery." (REALLY? What a shocker. Can I have that in writing?) Annoyed and half-crazed with lack of sleep (my specific sleep issues will play a part later in this blog, to be sure), I feigned patience and told him it was just not in the cards right now, as my current insurance wouldn't cover it, I didn't have five figures in cash lying around, and if I did, I'd pay my student loans off with it. I said something vague about the lap band--that I was looking into it. Needing no further encouragement, he pounced on it like a dime-eyed cat with a catnip mouse.

"Gastric bypass would be better for you," he persisted. "You'd lose more weight in less time."

I don't have a lot of patience to begin with, and what I was faking was completely gone. "Gastric bypass," I replied curtly, "sounds like something some Nazi thought up." I realize that is a rather offensive way to put it, but I was offended, too, and he dropped the subject, which was all I was trying to accomplish.

Gastric bypass, as I understood it at that time, did sound like something some Nazi thought up. Cut a person open, re-route stuff, permanently alter other stuff, it just didn't sound like anything any human being should do to another. It still doesn't sound like the most fun anyone's ever had. I know you can't eat more than a few bites, the food to be thoroughly chewed or it can get stuck, you can throw up a lot, etc. What other people did was their own business, but for me? Never.

Lap band sounded better to me--adjustable, reversible, not so extreme--and I kept reading about other weight-loss surgeries, like the stomach-sleeve gastrectomy. The Realize band started to be advertised on TV a lot recently, and it sounds good. One benefit of dragging my feet all this time is that technology and knowledge keeps improving, and I can continue to learn more and more. There has also been documented medical proof that my weight stays in a certain range despite a number of different eating plans and exercise programs.