Posted on December 30, 2011 at 2:21 PM in Bariatric Surgery, Insurance, Weight Loss Surgery
It’s hard to believe 2011 has passed and we hope everyone has had a successful year. We have had a great year here at New Life Center for Bariatric Surgery by having the pleasure of scheduling many patients for surgery, and have also been fortunate to meet a lot of new faces who will be having surgery with us next year.
Just as a reminder for everyone who will have appointments at our office next year, please be prepared to fill out paperwork and bring your current insurance card(s) with you to your appointment. Even if your insurance provider remains the same, the information on your card will change and we need to make sure we get the correct information. We understand it can be frustrating completing paperwork every time you come in for an appointment, but it would be more frustrating if we could not reach you by mail or phone because there was a demographic change that was not updated.
We would also like for everyone to be mindful of their appointment dates and times. As our New Life family grows, we find the schedule fills faster and it can sometimes take a few weeks to get an opening in the schedule. For this reason, we would really appreciate patients giving us notice that you will not be able to keep your appointment. We keep a cancellation list for patients needing to be seen, but this list only works if we know ahead of time who will not be here. Unlike many other medical offices, we do not charge for missed appointments because we know that sometimes things happen beyond your control, but we would appreciate a phone call to let us know you will be unable to make it.
We always look forward to seeing patients when they come into the office to purchase vitamins and supplements, but for those of you who drive a distance to get here or have a hard time coming by during office hours, we have the online store available to you 24 hours a day. In fact, if you make a purchase over $50.00, it is shipped to you for free. You can reach our online store at www.newlifebariatricsurgery.com. In a day and time where most people are struggling with their time and finances, it is nice to have this service offered.
We wish everyone a Merry Christmas and Happy New Year. We are looking forward to seeing each and every one of you in 2012.
Posted on November 17, 2011 at 4:01 PM in Bariatric Surgery, Nutrition, Weight Loss Surgery
Vitamins and minerals fall into a category called micronutrients. They function in our body as co-factors and enzymes that are necessary to complete every process in our bodies from our head to our toes. Unlike macronutrients (protein, carbohydrates and fats), they do not provide calories. Vitamins and minerals are necessary for healthy vision, cell growth and development, healthy skin, bones and teeth, immunity, wound healing, metabolism of nutrients, healthy brain and nerve function, normal heart rhythm and function, reproduction and much more! (1). Vitamins and minerals are found throughout all the food groups in a variety of foods and beverages. They are abundantly found in fruits and vegetables of all colors and sizes, protein sources like chicken, eggs and beans, dairy products like milk and cheese and in a variety of whole grains.
Vitamins and minerals play an important role in weight control and management! Micronutrients assist in many of the processes that regulate appetite and hunger hormones, metabolic rate, nutrient absorption and storage, glucose homeostasis and more! Therefor, adequate intake of vitamins and minerals is crucial for our body to appropriately use the nutrients we consume, a healthy and active metabolism, hunger control and ultimately optimal weight loss and long-term weight maintenance (1).
So how does vitamin and mineral supplementation affect the bariatric surgery patient? Before surgery vitamin and mineral supplementation is recommended to help boost your nutritional status. Your nutritional status prior to surgery is a good indicator of your healing process after surgery. The healthier you are prior to surgery the stronger your immune system and more efficient your wounds will heal and the shorter the recovery time (2).
After surgery, patients have an increased need for vitamin/mineral supplementation due to one of the three following procedural categories: restrictive, mal-absorptive or mixed procedures. Restrictive procedures limit the amount of food a person can consume. Mal-absorptive procedures limit the amount of calories you absorb and mixed procedures are a combination of both. All of the procedures restrict or limit food you consume and/or absorb and therefor restrict or limit the amount of micronutrients you consume and/or absorb. Patients who do not take their bariatric specific vitamins as prescribed will develop vitamin/mineral deficiencies. These deficiencies can lead to, but are not limited to, fatigue, weakness, headache, calf and leg pain, loss of night vision, dry skin and nails, seizures, cardiac arrhythmias, poor immune function, osteoporosis, neurological damage, neuropathy and even death (1).
In conclusion, patients who have bariatric surgery must take bariatric specific vitamins as prescribed before surgery and for the rest of their lives after surgery to promote health, healing, weight loss and weight maintenance and to prevent vitamin and/or mineral deficiencies.
Jennifer Jarrett Clark MS, RD, LDN
Registered Dietitian
Sources:
1. Source: Aills et al. ASMBS Allied Health Nutritional Guidelines for the Surgical Weight Loss Patient. Surgery for the Obesity and Related Diseases 8 (2008)
2. Source: Jacques, Jacqueline. Micronutrition for the Weight Loss Surgery Patient. Matrix Medical Communities :Edgmont, PA;1996
Posted on November 15, 2011 at 12:01 AM in Bariatric Surgery, Dr. Boyce In The Media
Knoxville Bariatric Surgeon Now Performing Laparoscopic Greater Curve Plication Weight Loss Procedure
Knoxville bariatric surgeon Dr. Stephen Boyce is now performing laparoscopic greater curvature plication (LGCP) at his practice. He says the new procedure is designed to help patients lose significant amounts of excess body weight without removing stomach tissue or introducing foreign body implants. He also says he is excited about the procedure’s potential for patients to lose more than 50% of their excess body weight and improve their daily life through a healthier body.
At the New Life Center for Bariatric Surgery in Knoxville, Dr. Stephen Boyce is offering laparoscopic greater curvature plication (LGCP), a procedure approved for patients with a body mass index of 30 or greater. Performed without the introduction of foreign body implants or stomach tissue removal, Dr. Boyce says the LGCP technique reduces stomach capacity from an average of 32 ounces of liquid to 4 ounces, causing patients to feel full earlier during meals. Although the LGCP procedure is still in clinical trial, Dr. Boyce says, compared with other weight loss surgery procedures, gastric plication in Knoxville has proven to eliminate many of the risks associated with procedures that involve removing parts of the stomach or imposing foreign implants such as with the LAP-BAND® System.
LGCP is performed by dissecting one side of the stomach, allowing access to both the front and back surfaces, and then folding in the rounded part of the stomach and sewing it together. The result is a narrowed stomach diameter, allowing patients to experience fullness after eating less amounts of food. Because LGCP does not involve removal or rearrangement of the stomach or bowel, Dr. Boyce says the surgery is less risky than other traditional methods of weight loss procedures. “Early studies indicate that the LGCP is a safe, effective and less expensive weight loss surgical option for patients with a BMI between 30-50.”
Dr. Boyce says he hopes the new gastric plication technique will allow him to offer his patients in East Tennessee more options for weight loss procedures. He also adds that LGCP can provide patients with an innovative and advanced way to lose weight and gain confidence on the journey towards healthier living. Dr. Boyce says he looks forward to the what the future of bariatric surgery will bring and how procedures like LGCP can pave the way for more developments in weight loss. “I am most excited that new bariatric procedures like the LGCP will make bariatric surgery more accessible to patients who need help.”
About Stephen G. Boyce, MD
Dr. Stephen Boyce received his undergraduate degree from Texas A&M University and his medical degree from the University of Texas Southwestern Medical School. He completed his surgical residency at Parkland Memorial Hospital and went on to receive special training in advanced laparoscopic surgery and a Masters Certification in Bariatric Surgery. Dr. Boyce developed the New Life Center for Bariatric Surgery in 2002, becoming one of the nation’s first Centers of Excellence in 2005. His practice is also the only Center of Excellence in East Tennessee to offer all approved Bariatric operations.
New Life Center for Bariatric Surgery is located at 200 Ft. Sanders West Blvd MOB 1, Suite 200 in Knoxville, TN and can be contacted at (865) 694-9676. It also can be reached at parkwestcwlc.com or facebook.com/newlifecenterbariatricsurgery.
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Posted on October 19, 2011 at 4:46 PM in Bariatric Surgery, Exercise, Uncategorized, Weight Loss Surgery
Physical Activity/Exercise Guidelines
The American College of Sports Medicine (ACSM), the American Heart Association (AHA), and the US Department of Health and Human services released guidelines for physical activity/exercise in 2008. Before the guidelines are discussed the difference between physical activity and exercise must be clearly defined.
• Physical activity: any bodily movement produced by the contraction of skeletal muscle that increases energy expenditure above a basal (rest) level. This includes personal grooming/hygiene, feeding oneself, standing, walking from parking lot to entrance of building, family care, household chores, occupational requirements, gardening, and so on.
• Exercise: is structured physical activity specifically designed to improve one’s cardiovascular fitness, muscular strength/endurance, flexibility, and body composition (lean mass/fat mass).
• All exercise is physical activity but not all physical activity is exercise.
Cardiovascular Recommendations:
Most if not all days of the week (3-5 days/week) for at least thirty minutes per day. Moderate intensity level: Working hard enough to raise your heart rate and break a sweat, yet still being able to carry on a conversation (talk test).
METs: A metabolic equivalent or MET is a unit useful for describing the energy expenditure for a specific activity. A MET is the ratio of the rate of energy expended during an activity to the rate of energy expended at rest. Example: 1 MET is the rate of energy expenditure at rest, expressed as 3.5 ml/kg/min or 1 kcal/kg/h or 4.184 kj/kg/h. A 4 MET activity expends four times the energy used by the body at rest.
Two methods of assessing aerobic intensity:
1. Absolute Intensity (Overall guide)
Light: are defined as 1.1 to 2.9 METS
Moderate: are defined as 3.0 to 5.9 METS. Walking at 3.0 mph requires 3.3 METS of energy expenditure
Vigorous: are defined as > 6.0 METS. Running at 10 minute/mile pace is a 10 MET activity
2. Relative Intensity (Specific to individual): Intensity expressed in terms of percent of maximal heart rate, heart rate reserve or aerobic capacity reserve.
Moderate: 40-59% of aerobic capacity reserve (0% resting and 100% maximal) or a 5-6 on a scale of 0-10 (0=sitting, 10=maximal effort)
Vigorous: 60-84 % of aerobic reserve capacity or a 7-8 on a scale of 0-10
Four classifications of cardiovascular exercise:
Inactive: no activity beyond baseline activities of daily living.
Low Activity: <150 minutes (2.5 hours) of moderate intensity exercise or 75 minutes (1.25 hours) of vigorous intensity exercise per week.
Medium Activity: 150-300 minutes (2.5-5 hours) of moderate intensity activity or 75-150 minutes (1.25-2.5 hours) of vigorous intensity exercise per week.
High Activity: > 300 minutes (> 5 hours/week) of moderate intensity exercise.
A good rule of thumb is that vigorous intensity exercise requires only 50% of the weekly duration (time) of moderate intensity exercise to obtain the same health benefits.
The greater the amount of regular exercise (moderate or vigorous) performed on a weekly basis the greater the health benefits. Examples below:
Lower risk for premature death (17-28 years)
Lower risk for coronary heart disease (CHD)
Lower risk of stroke
Lower risk for hypertension (High blood pressure)
Lower risk for dyslipidemia (High cholesterol)
Lower risk for Type 2 diabetes mellitus
Reduced depression
Improvement in cognitive function
Reduction in the number of falls
Cardiovascular Activity
Any activity where the body’s large muscles move in a rhythmic manner for a sustained period of time (i.e. brisk walking, running, cycling, jumping rope, swimming, and hiking).
Three components to consider when selecting an activity (FIT Principle):
Frequency: how often on a weekly basis is the exercise performed.
Intensity: how hard to work during the activity. Moderate = brisk walking, vigorous = jogging/running.
Time: how long (duration) each session should last (i.e. 10-60 minutes).
Greg Stanley, MS, CSCS, HFS
Exercise Physiologist
Posted on September 14, 2011 at 11:35 AM in Bariatric Surgery, Weight Loss Surgery
Obstructive sleep apnea is a potentially serious sleep disorder in which breathing repeatedly stops and starts during sleep. Several types of sleep apnea exist, but the most common type is obstructive sleep apnea, which occurs when your throat muscles intermittently relax and block your airway during sleep. The most noticeable sign of obstructive sleep apnea is snoring, although not everyone who has obstructive sleep apnea snores. Signs and symptoms of obstructive sleep apnea include:
• Excessive daytime sleepiness (hypersomnia)
• Loud snoring
• Observed episodes of breathing cessation during sleep
• Abrupt awakenings accompanied by shortness of breath
• Awakening with a dry mouth or sore throat
• Morning headache
• Frequent urination at night
• Difficulty staying asleep (insomnia)
Many people don’t think of snoring as a sign of something potentially serious, and not everyone who has sleep apnea snores. When the muscles in your throat relax, your airway narrows or closes as you breathe in and breathing may be inadequate for 10 to 20 seconds. This may lower the level of oxygen in your blood. Your brain senses this inability to breathe and briefly rouses you from sleep so that you can reopen your airway. This awakening is usually so brief that you don’t remember it. You can awaken with a transient shortness of breath that corrects itself quickly, within one or two deep breaths, although this sequence is rare. You may make a snorting, choking or gasping sound. This pattern can repeat itself five to 30 times or more each hour, all night long. These disruptions impair your ability to reach the desired deep, restful phases of sleep, and you’ll probably feel sleepy during your waking hours. People with obstructive sleep apnea may not be aware that their sleep was interrupted. In fact, many people with this type of sleep apnea think they sleep well all night. Anyone can develop obstructive sleep apnea. However, certain factors put you at increased risk:
• Excess weight
• Neck circumference. A neck circumference greater than 17 inches (43 centimeters) for men and 15 inches (38 centimeters) for women
• High blood pressure (hypertension)
• A narrowed airway
• Chronic nasal congestion
• Diabetes
• Being male. In general, men are twice as likely to have sleep apnea
• Being black, Hispanic or a Pacific Islander
• Being older than 65
• Menopause
• A family history of sleep apnea
• Use of alcohol, sedatives or tranquilizers
• Smoking. Smokers are nearly three times more likely to have obstructive sleep apnea
Sleep apnea is considered a serious medical condition. Complications may include:
• Cardiovascular problems. Sudden drops in blood oxygen levels that occur during sleep apnea increase blood pressure and strain the cardiovascular system. If there’s underlying heart disease, these repeated multiple episodes of low blood oxygen (hypoxia or hypoxemia) can lead to sudden death from a cardiac event.
• Daytime fatigue. The repeated awakenings associated with sleep apnea make normal, restorative sleep impossible. People with sleep apnea often experience severe daytime drowsiness, fatigue and irritability. Treatment of sleep apnea can improve these symptoms, restoring alertness and improving quality of life.
• Complications with medications and surgery. Obstructive sleep apnea also is a concern with certain medications and general anesthesia. People with sleep apnea may be more likely to experience complications after major surgery because they’re prone to breathing problems, especially when sedated and lying on their backs. Before you have surgery, tell your doctor that you have sleep apnea. Undiagnosed sleep apnea is especially risky in this situation.
• Sleep-deprived partners. Loud snoring can keep those around you from getting good rest and eventually disrupt your relationships.
• People with obstructive sleep apnea may also complain of memory problems, morning headaches, mood swings or feelings of depression, and a need to urinate frequently at night (nocturia).
If you suspect that you have obstructive sleep apnea, you’ll likely first see your primary care doctor. Your doctor may refer you to an ear, nose and throat doctor to rule out any anatomic blockage in your nose or throat. However, in some cases, you may be referred immediately to a sleep specialist. The evaluation may involve overnight monitoring of your breathing and other body functions during sleep. Tests to detect sleep apnea include:
• Nocturnal polysomnography. During this test, you’re hooked up to equipment that monitors your heart, lung and brain activity, breathing patterns, arm and leg movements, and blood oxygen levels while you sleep. This can help your doctor rule out other conditions — such as periodic limb movements or narcolepsy — that can also cause excessive daytime sleepiness, but require different treatment.
• Oximetry. This screening method involves using a small machine that monitors and records your blood oxygen level while you’re asleep. A simple sleeve fits painlessly over one of your fingers to collect the information overnight at home. If you have sleep apnea, the results of this test will often show drops in your blood oxygen level during apneas and subsequent rises with awakenings. If the results are abnormal, your doctor may have you undergo polysomnography to confirm the diagnosis. Oximetry doesn’t detect all cases of sleep apnea, so your doctor may still recommend a polysomnogram even if the oximetry results are normal.
• Portable cardiorespiratory testing. Under certain circumstances, your doctor may provide you with at-home tests to diagnose sleep apnea. These tests usually involve oximetry, measurement of airflow and measurement of breathing patterns.
• To eliminate snoring and prevent sleep apnea, the sleep specialist may recommend a device called a nasal continuous positive airway pressure (CPAP) machine. With this treatment, the pressure of the air breathed is continuous and somewhat greater than that of the surrounding air, which is just enough to keep your upper airway passages open. This prevents apnea and snoring. With some practice, most people learn to adjust the mask to obtain a comfortable and secure fit. You may need to try different types to find a suitable mask.
Don’t stop using the CPAP machine if you experience problems. Check with your doctor to see what adjustments you can make to improve its comfort. In addition, contact your doctor if you still snore despite treatment or begin snoring again. If your weight changes, your doctor may need to adjust the pressure settings but it is important to continue using your appliance until further testing indicates otherwise.
For milder cases of obstructive sleep apnea, your doctor may recommend lifestyle changes, such as losing weight or quitting smoking. If these measures don’t improve your signs and symptoms or if your apnea is moderate to severe, a number of other treatments are available. Certain devices can help open up a blocked airway. In other cases, surgery may be necessary.
Try these tips:
• Lose weight. Even a slight loss in excess weight may help relieve constriction of your airway.
• Avoid alcohol and medications such as tranquilizers and sleeping pills. These relax the muscles in the back of your throat, interfering with breathing.
• Sleep on your side or abdomen rather than on your back. To prevent sleeping on your back, try sewing a tennis ball in the back of your pajama top.
• Keep your nasal passages open at night. If you have congestion, use a saline nasal spray to help keep your nasal passages open.
Also of interest, there is a direct correlation between untreated sleep apnea and weight gain. Interrupted sleep cycles can affect hormone production in the body resulting in a metabolic disorder that causes weight gain. A follow up sleep study isn’t always necessary, especially if your machine is equipped with a memory card that records your oxygen needs at night. This chip can be brought to the sleep center and adjustments can be made from that information without the need for a full follow up sleep study. The Parkwest sleep center also has home monitoring options available for people who cannot come to the sleep center. If you have been requested to follow through with a sleep study, I hope this information details the importance of scheduling that appointment.
Robin H. Saunders, RN, BSN
Posted on August 3, 2011 at 2:52 PM in Bariatric Surgery, Exercise, Weight Loss Surgery
Each year many of us give our time, effort, and money to help those in need and to support a worthy cause. We support school fundraisers, Girl Scouts, Boy Scouts, and the local soccer and football teams. You name it and we have all given at least a dollar to it. The New Life Center for Bariatric Surgery would like your help in supporting the fight against obesity.
Most likely, every person reading this knows someone affected by obesity, whether it is a family member or a friend. The Obesity Action Coalition, American Society for Metabolic and Bariatric Surgery (national and TN chapters) and New Life Center for Bariatric Surgery are bringing the Walk From Obesity to Knoxville (well, Farragut actually). The money raised from the walk helps support OAC and the ASMBS Foundation in research, education, public awareness and advocacy for obesity. This is the first year our office has helped to host the walk and we are very excited about it. It will take place on the 24th of September at 10 am at McFee Park in Farragut. The event will consist of a short walk to raise money for obesity awareness and research. There will be lots of activities for children, too!
In the last 20 years Tennessee’s rate of adult obesity has risen from 10-14% to over 30%; more than doubling the percentage! In addition, 10-15% of children in the state of Tennessee are obese. It’s time for ACTION! We have an opportunity to raise awareness about the epidemic and to educate our kids about obesity. Will you join our staff in the Walk From Obesity?
I challenge each of you to participate to the utmost of your ability. My goal is to have 120 participants. If each participant raises $50 we would raise over $5000 for the cause. If each of our past patients give $10, we would raise over $300,000! That would be amazing! Please help us in whatever way you can, whether by walking, raising money, donating a door prize, or donating money. Your help is greatly appreciated.
Call me, Sarah, at 865.694.9676 or email me at sgrimes@premiersurgical.com if you wish to donate a door prize or gift. Go to www.walkfromobesity.com to register.
Sarah Grimes, RN, CBN
Bariatric Coordinator
New Life Center for Bariatric Surgery
Posted on July 16, 2011 at 6:47 PM in Bariatric Surgery, Dr. Boyce In The Media, From the Desk of Dr. Boyce
The Bariatric Post-Operative Experience
The purpose of this study is to describe the life changes that occur in the 12 to 18 months after undergoing bariatric surgery.
Thank You for My New Life: The Bariatric Post-Operative Experience written by
- Angela F. Wood RNC, NNP-BC, PhD Associate Professor, Carson-Newman College
- Stephen G. Boyce MD, FACS, FASMBS Medical Director, New Life Center for Bariatric Surgery
- Jama K. Stinnett LPN, CPHQ Program Coordinator for new Life Benter for Bariatric Surgery
Click here to read Thank You for My New Life
Posted on April 4, 2011 at 11:10 AM in Bariatric Surgery, Weight Loss Surgery
Hello again from the front desk staff!
As always, we are creating new ways to improve patient care here at New Life. To all of you patients who have upcoming follow up appointments, you will be receiving a letter in the mail requesting that you to come in two weeks prior to your appointment for lab work. The goal of this is to have all of the results of your blood work when you come in for your appointment so that they can be reviewed with you while you are in the office. We have found that discussing any lab abnormalities in person, as opposed to receiving letters or phone calls, makes instructions for treatment much easier to comprehend.
We understand that there are circumstances that prevent some patients from coming in for labs prior to their appointment, such as long distance driving. Not to worry, though, you can do your labs near your home and bring the results or as a last resort, we can still do this blood work on the day of your appointment while you are in the office and follow up with you by phone or mail.
Please note, also, that when blood is drawn in our office it is billed through Quest Diagnostics and not Premier Surgical. Anytime labs are done at our office it is NOT included in any pre-paid fees and will be a separate cost. Your insurance will be billed for the services and if you are responsible for any co-pays or deductibles you will receive a bill in the mail informing you of your balance. If you have any questions about billing or want to make a payment on a bill for Quest Diagnostics, contact information is listed on your statement.
Our goal is to help you achieve yours, and with your help we can all be successful!
Posted on January 3, 2011 at 3:01 PM in Bariatric Surgery, Insurance
The insurance approval process prior to bariatric surgery can be very confusing and frustrating, but with a little patience and determination you will reach your goal and be ready for surgery. The Pre-Determination Coordinator is a full-time employee dedicated to helping you decipher your insurance’s requirements, meet the criteria set forth, and get you approved for your surgery. A helpful tip may be to outline the criteria specific to you, and create a checklist for yourself. It is very helpful to be able to see what needs to be done and very affirming to see all that you have accomplished. All insurance companies require patients to be morbidly obese. A person with a Body Mass Index (BMI) of 35-39.9 with a comorbid condition such as Hypertension, Diabetes II, Obstructive Sleep Apnea requiring the use of a device such as a CPAP, or Degenerative Joint Disease meets the criteria. Patients with a BMI that is greater than 40 are not typically required to have a diagnosed comorbid condition. Medicare is the exception to this rule. All patients with Medicare or a Medicare replacement policy must have a diagnosed comorbid condition regardless of BMI.
There are 2 main categories to address prior to having surgery:
1: Requirements everyone must meet
2: Requirements specific to your insurance policy.
The first category, requirements that everyone must meet, applies to patients whether they are paying for surgery on their own or going through their insurance company. After attending a seminar and having a consultation with one of the surgeons, everyone must undergo psychiatric evaluation by a doctorate level psychiatrist or psychologist and receive a mental health clearance. The psychiatric evaluation usually consists of a combination of personality testing and an interview. Patients must also be given a medical clearance by their primary care physician. A letter stating that you are cleared for bariatric surgery is sufficient. Your surgeon may want you to have other specific clearances from any specialized physicians that you see. This will be discussed with you at your consultation. We also ask all patients to attend at least one (1) bariatric support group meeting. There are several different groups to choose from located in the area surrounding Knoxville to increase convenience and accessibility to everyone. Each support group meets once monthly. We will supply you with a list of the support groups, when and where they meet, and directions. This list can also be found on our website.
The second category, requirements that are specific to an insurance company, can vary greatly. The most common requirements of an insurance company are medically supervised dieting, documentation of weight history, and evaluations by a dietitian and/or exercise physiologist. A medically supervised diet is usually 6 consecutive months in duration with at least one (1) office visit monthly. However, some insurance companies only require a three (3) month medically supervised diet, and a few do not require a diet at all. Usually your initial consultation with the surgeon is considered the first month of your medically supervised diet, but a few insurance companies require that all 6 visits be with a primary care physician. During your medically supervised diet you may be required to meet with a dietitian and an exercise physiologist. These appointments will also be considered a medically supervised diet visit so you will not have to be seen 2 times in one month.
For example, an insurance that requires a 3 month diet with a dietitian and exercise physiologist evaluation could be done as follows:
Month 1 – Consultation with surgeon. Month 2 – Meet with exercise physiologist. Month 3 – Meet with dietitian. At this point your medically supervised diet would be complete.
Medically supervised diet visits can usually be done with your primary care physician or with Covenant Weight Management Center. Remember though, some insurance companies do require that the diet be done with a primary care physician.
Your insurance company may also ask to see documentation that you have been morbidly obese for an extended period of time, usually five (5) years. One office note per year for each of the previous 5 years with a documented weight will satisfy this requirement. If you doctor uses a form to record the date and your weight at each office visit, sometimes called a ‘vitals sheet,’ we can use that as well.
Once you have completed these requirements it is time to request approval for your surgery. The Pre-D Coordinator will assemble a packet and pre-approval surgery request letter. This packet will be sent to your insurance company for review by a nurse coordinator and medical director. The average amount of time to hear back from an insurance company is 2 weeks. Some take longer and some respond sooner. When we receive the approval letter from your insurance you will be contacted by our office. If, for any reason, we receive a denial, the Pre-D Coordinator will research as to why the request was denied and begin working with you and your insurance to rectify the situation and gain approval. There are some instances in which a denial cannot be overturned. An insurance policy that excludes bariatric surgery will not overturn a denial since the service is not a covered benefit. Denials due to the patient not meeting the specific requirements set forth by the insurance company are handled on an individual case-by-case basis.
Thank You!
Jennifer Wood
Pre-Determination Coordinator
Posted on December 6, 2010 at 1:31 PM in Bariatric Surgery, Weight Loss Surgery
Have you ever stopped to think of all that is involved with just a simple doctor’s appointment? Have you ever considered that how you manage your own appointments impacts the office staff and especially the other patients? Well, this may come as a surprise to some, but it absolutely does! Here at New Life we strive to achieve the ultimate patient satisfaction and with your help we can reach our goal. We are proud to say that we have a very large patient population which requires us to see a great number of patients per day. It is very important that appointments run as smoothly as possible so that each patient receives the quality care that they deserve. With that being said, we would like to give some tips on appointment etiquette to ensure a happy and harmonious New Life family.
We realize that entering into the process to pursue Bariatric surgery is exciting. After attending our informational seminar most patients are “fired-up” and ready to get the ball rolling. While we are thrilled that patients are so enthusiastic to get in for their consultation, a common mishap is for patients to absent-mindedly schedule appointments without considering their work-schedules, child care, travel time, etc. As a result, patients no-show or cancel appointments last minute. We strongly encourage that if you know you will be unable to make your appointment to call and inform the staff at your earliest convenience as it will give another patient the opportunity to come in at that time. Fortunately, we do have a cancellation list in place to offer patients the chance to come in for earlier appointments, but it cannot be used to its fullest potential if we are not notified of cancellations in a timely manner.
We all know that there is the chance of “the unknown” just around every corner. We encourage patients to always allow time for situations such as traffic and bad weather when traveling to your appointment. Please ensure that you know directions to our office, also. There are several locations that we reference to patients for seminars, support group meetings, office visits, etc. and it can be confusing to patients when scheduling appointments. Even if you are confident of our location it never hurts to ask and the staff is more than willing to direct you. While your consultation is a very exciting visit, most patients tend to be nervous about stepping into this life altering process and we certainly would like to prevent the added stress of being lost! Keep in mind that the flow of your own appointment affects that of the other patients’ as well. If for any reason you should be late to your appointment please notify the office staff. If you are expected to be more than a few minutes late you may be asked to reschedule your appointment or wait while another patient is seen.
Preparation is key when it comes to having a productive visit. We try our best to supply you with all of the necessary paperwork prior to your visit to cut down on your wait time in the reception area. At our informational seminar we supply patients with a packet to complete which includes basic patient information, such as your address and phone number, consent forms, and medical history. This packet is very lengthy and takes an average of thirty minutes or more to fill out. Patients that are already established with our practice will be asked to update their basic patient information annually. We attempt to mail this paperwork in advance so that patients do not have to take time out of their visit to fill it out. Please have all of this paperwork completed when you arrive at our office to prevent yourself and other patients from having to wait for an extended period of time. To any post op patients, there will be some form of follow up paperwork for you to fill out at almost every visit to aid the clinical staff in your visit. Please arrive for your appointment ten minutes early to complete any necessary paperwork. Some other pieces of vital information are your insurance card and drivers’ license. It is very important that we have correct insurance information on file at all times. Failure to notify staff of insurance changes may result in patients being financially responsible for services. Also, be attentive to any instructions given to you for your appointment. On some occasions you may be asked to come fasting. If no instructions are specified to you in your paperwork or by a staff member please ask for confirmation.
We greatly appreciate the cooperation and assistance of all of our patients. If we will all be considerate of each other and how our own actions affect those around us we can be successful in creating a relaxed and satisfying environment.
“We are willing to commit, if you are!”
Thank you from front desk ladies at New Life
