Bariatric Surgery: Pre-Operative Process
Why does it take so long to get insurance approval?
After all of your consultations/testing are completed, it usually takes your doctor 1-2 days to send a letter to your insurance carrier to begin the approval process. The time it takes to get decision from your insurance provider can vary from 4-6 weeks or longer if you are not persistent in your follow-up. Most treatment centers have insurance analysts who will follow up regularly on approval requests. It may be helpful for you to call the claims service of your insurance company about a week after your letter is submitted and ask about the status of your request.
What are the routine tests before surgery?
Certain basic tests are done prior to surgery: a Complete Blood Count (CBC), Urinalysis, and a Chemistry Panel, which gives us results of about 20 blood chemistry values. Often a Hemoglobin A1C is done to evaluate for diabetes. All patients are required to complete a chest X-ray and an electrocardiogram. Women may have a vaginal ultrasound to look for abnormalities of the ovaries or uterus. Other tests, such as pulmonary function testing, echocardiogram, sleep studies, GI evaluation, cardiology evaluation and gallbladder ultrasound may be requested when indicated.
What is the purpose of all the tests?
An accurate assessment of your health is needed before surgery. The assessment will help us to avoid potential complications. It is important to know if your thyroid function is adequate since hypothyroidism can lead to sudden death post-operatively. If you are diabetic, special steps must be taken to control your blood sugar. Since surgery increases cardiac stress, your heart will be thoroughly evaluated. Other tests will determine if you have liver malfunction, breathing difficulties, excess fluid in the tissues, abnormalities of the salts or minerals in body fluids, or abnormal blood fat levels.
Why do I have to have a GI Evaluation?
Patients who have significant gastrointestinal symptoms such as upper abdominal pain, heartburn, belching sour fluid, etc. may have underlying problems such as a hiatal hernia, gastroesophageal reflux or peptic ulcer. GERD and hiatal hernia are common among obese individuals. Up to 15% of patients with reflux symptoms may show early changes in the lining of the esophagus. Esophageal changes could predispose them to cancer of the esophagus. It is important to identify these changes so a suitable surveillance or treatment program can be planned.
Why do I have to have a Sleep Study?
Sleep Apnea can decrease a lifespan by 20 years. The sleep study detects a tendency for abnormal stopping of breathing typically associated with airway blockage when the muscles relax during sleep. This condition is associated with a high mortality rate. After surgery you will be sedated and will receive narcotics for pain. Narcotics further depress normal breathing and reflexes. Airway blockage becomes more dangerous at this time. It is important to have a clear picture of what to expect and how to handle it.
Why do I have to have a Psychological Evaluation?
The most common reason a behavioral and psychological evaluation is ordered is that your insurance provider requires it. The goal of the behavioral and psychological health evaluation is to evaluate your understanding and knowledge of the risks and complications associated with weight loss surgery and your ability to follow the basic recovery plan.
What impact do my medical problems have on the decision for surgery, and how do the medical problems affect risk?
Medical problems, such as serious heart or lung problems, can increase the risk of any surgery. When medical problems are related to the patient’s weight they also increase the need for surgery. Severe medical problems may not dissuade the surgeon from recommending weight loss surgery if it is otherwise appropriate. However, certain serious medical conditions will make a patient’s risk higher than average.
If I want to undergo a gastric bypass or Lap Band surgery, how long do I have to wait?
After you have attended one of our bimonthly seminars, a one-on-one consultation can be scheduled with one of our surgeons within a week or two. If the surgeon and patient agree it is appropriate to move forward with bariatric surgery, the time before surgery is determined by your insurance provider and the time it takes to obtain the appropriate preoperative tests completed.
What can I do before the appointment to speed up the process of getting ready for surgery?
- Select a primary care physician if you don’t already have one, and establish a relationship with him or her. Work with your physician to ensure that your routine health maintenance testing is current. For example, women may have a pap smear, and if over 40 years of age, a breast exam. And for men, this may include a prostate specific antigen test (PSA).
- Make a list of all the diets you have tried (a diet history) and bring it to your doctor.
- Bring any pertinent medical data to your appointment with the surgeon – this would include reports of special tests (echocardiogram, sleep study, etc.) or hospital discharge summary if you have been in the hospital.
- Bring a list of your medications with dose and schedule.
- Stop smoking. Surgical patients who use tobacco products are at a higher surgical risk.
How do I prepare for bariatric surgery?
- Be sure to have all of your supplies needed for recovery. Remember that your movement will be limited.
- Follow all medication directions. Have your postoperative prescriptions filled promptly.
- Be sure to have one or more persons available to drive you home after surgery and provide any assistance you may need concerning personal hygiene, food preparation, carrying items, etc., immediately after surgery and for your recovery period. Be sure your helpers are aware of special care instructions you may have received.
- Do not smoke for at least 30 days before your surgery because it may increase your risk of postoperative pneumonia.
- Do not drink alcohol for at least 48 hours before surgery.
- Join a bariatric support group that can help you in your transition to a healthier life. The Bariatric Support Group at MacNeal meets every third Thursday of the month.
How do I prepare the night before surgery?
- Follow your surgeon’s directions about avoidance of eating and drinking before surgery.
- Have all personal items packed.
- Leave all valuables at home, including jewelry, credit cards and cash.
- Make sure your glasses or contacts are safely stored during surgery.
- Bring comfortable clothes to wear after the procedure.
- Make sure to have your insurance card and any documents such as medical power of attorney, advance directive, or living will readily available.
- Bring all informational documents you received from your surgeon and registered dietitian.
We’re here to help. Call (888) 622-6325 for more information or Request an Appointment with a Bariatric Specialist at MacNeal Hospital.