A Comprehensive Approach to Transforming Lives through Bariatric Surgery

Transcription

1 A Comprehensive Approach to Transforming Lives through Bariatric Surgery

2 Saint Clare s Center for Weight Loss Surgery If you are more than pounds overweight and have tried and failed to lose weight, or if you suffer from obesity-related health problems such as heart disease, diabetes or sleep apnea, joint disease or infertility, weight loss surgery may be an option. In an effort to educate potential patients on the procedure and its short and long-term benefits, the Center hosts several New Patient Seminars each month. Answering the growing demand for a surgical alternative for serious weight problems, The Center for Weight Loss Surgery, located at Saint Clare s Hospital/Dover, is recognized by the American Society for Metabolic and Bariatric Surgery and the Surgical Review Corporation as a Bariatric Surgery Center of Excellence. The center, and its specially-trained staff, is led by accomplished laparoscopic bariatric surgeons who are also respected members of the American Society for Metabolic and Bariatric Surgery. The Center for Weight Loss Surgery offers gastric banding or gastric bypass surgery. Gastric banding restricts the amount of food a patient can ingest during meals. Gastric bypass surgery restricts the amount of food while also decreasing the amount of food absorption in the gastrointestinal system. Long-term, consistent weight loss is contingent upon following recommended meal plan guidelines and participating in support groups. This brochure offers a complete overview of the center, its surgeons, and the bariatric surgery procedures. In an effort to educate potential patients on the procedure and its short and long-term benefits, the Center hosts several New Patient Seminars each month. Please call STCLARE ( ) for additional information. A Center of Excellence Through the Bariatric Surgery Centers of Excellence certification program, the American Society for Metabolic and Bariatric Surgery and the Surgical Review Corporation recognizes weight loss surgery centers nationwide for their commitment to stringent operational guidelines and benchmarks and their dedication to patient safety and advocacy. Surgeons can also receive certification after they meet certain skill, performance and eligibility requirements. The Center of Excellence certification also provides a nationwide platform for the continuous improvement of bariatric surgery through comparisons of patient selection, operative procedures and procedures of care. Centers who receive the certification participate in a centralized database that will guide decisions and respond to challenges by other centers, insurance carriers, and the public. Certified facilities also offer an invaluable resource for research that promotes enhancement to the overall practice of bariatric surgery. Bariatric Surgery Saint Clare s Health System 3

3 A Look at Bariatric Surgery Bariatric surgery, sometimes referred to as obesity surgery or weight-loss surgery, is designed to allow patients to achieve long-term, significant weight loss. The surgery drastically diminishes the caloric intake through restricting the amount of food that can be eaten and/or altering the absorption of it. Patients should have a solid understanding of the procedure and should be educated on what they need to do to live well after the operation. In 1991, a conference of the National Institutes of Health identified gastric weight-loss surgery as a safe and effective surgical treatment for obesity. This specialized surgery is intended for patients with a clearly documented history of failed diet attempts. These patients must be at least pounds overweight or have a Body Mass Index (BMI) of 40. Patients with a BMI of 35-40, with significant additional health problems such as heart disease, diabetes or sleep apnea, joint disease and/or infertility, may also be candidates for surgery. Patients are typically between 16 and 70 years old. Although the results of weight-loss surgery can be dramatic, there are potential risks and complications. Patients should have a solid understanding of the procedure and should be educated on what they need to do to live well after the operation. Our surgeons will discuss the signs or symptoms of complications to look for which may occur after your weight-loss surgery. The actual weight a patient will lose after the procedure is dependent on several factors. In general, weightloss surgery success is defined as achieving loss of 50% or more of excess body weight and maintaining that level for at least five years. Results vary by patient and bariatric surgeon. Ask your doctor for the clinical data stating the results of the procedure. Bariatric Surgery Saint Clare s Health System 5

4 A Minimally Invasive Solution to Bariatric Surgery Bariatric surgery, if performed laparoscopically, is minimally invasive, meaning patients may have fewer complications, experience less pain, are discharged from the hospital more quickly, and recover more easily. As use of the laparoscopic approach to bariatric surgery - which uses five small incisions and special instruments and scopes - has increased, the popularity of weightloss surgery has grown dramatically. Laparoscopic bariatric surgery holds a number of primary benefits over the more conventional invasive procedure, including: Reduction in infections and hernias at the surgical site. Bariatric surgery, if performed laparoscopically, is minimally invasive, meaning patients may have fewer complications, experience less pain, and are discharged from the hospital more quickly, and recover more easily. Reduced overall pain, enhancing immediate and long-term recovery and return to full function. Reduced hospital stay, typically averaging two days for laparoscopic gastric bypass patients. Laparoscopic gastric banding patients usually are discharged the same day. Reduced scarring, involving several very small incisions versus a large incision. Though the laparoscopic approach holds significant benefits, offers a quicker return to work and resumption of physical activity, and provides an improved cosmetic appearance, doctors may need to shift to a standard surgical procedure, via conventional incision, if necessary. Though the surgeon intends to perform the procedure laparoscopically, patients are required to provide consent for both procedures prior to surgery, allowing the surgeon to use discretion while in the operating room. Bariatric Surgery Saint Clare s Health System 7

5 Insurance and Weight Loss Surgery Behavioral health and nutrition screenings are required prior to having weight loss surgery at Saint Clare s. Hospital/Dover. Pre-Approval of Your Procedure Typically, your surgeon s office will submit the necessary information to your insurance provider in order to seek pre-approval. Pre-approval is almost always required for weight-loss surgery. This is an excellent way to make sure that this procedure is covered under your contract. It is best to contact the insurance company by phone and request a determination of your coverage amount prior to your procedure. Make sure to follow-up with your insurance company. If you have not received anything within a week of speaking with them, call back and confirm your request is being processed. Coverage The best way to find out if this procedure is covered under your plan is to call your insurance company. When calling, have your insurance card available and be sure to: Always document the date and time of calls, and with whom you spoke with. Keep a detailed record of all your documents. Ask the following questions, and write down all answers: Is weight loss surgery covered under your plan? Do you need a referral to see a bariatric surgeon? Do they require a Letter of Medical Necessity? Is your surgeon in network? If not, are you entitled to out of network benefits for bariatric surgery? Are you able to schedule an appointment with a dietician and a psychologist yourself directly, or do you need to be referred to them by your primary care physician? What requirements are stated in order to receive morbid obesity treatment? Must you lose weight prior to surgery? If so, what percentage or number of pounds is required? Do they require documented attempted weight loss? Does the documented time have to be consecutive? Is your physician required to document your weight loss attempts? Are there minimum or maximum weight or BMI limits for surgery? Must you use a specific Center of Excellence or specific medical provider to receive coverage? Appealing a Denied Prior Authorization Typically, your surgeon s office will submit the necessary information to appeal your denial. Denials are often a first response by many insurance providers. How you appeal the denial also depends if the plan is fully-insured or if it is self-insured by an employer. Bariatric Surgery Saint Clare s Health System 9

6 Procedures for Screening Appointments Behavioral health and nutrition screenings are required prior to having weight loss surgery at Saint Clare s. As a convenience to our patients, nutrition screenings are offered at Saint Clare s Hospital/Dover. Behavioral health screenings for weight loss surgery candidates are not provided by Saint Clare s, but are offered at our Dover campus. The doctors of Bariatric Psychiatric Associates, the practice offering these screenings, are not employees of Saint Clare s, but offer their services at our Dover location as a convenience to our patients. As a convenience to our patients, nutrition screenings are offered at Saint Clare s Hospital/Dover. These screenings are not always covered by insurance. If your insurance company does provide coverage for one or both of these services, they may have specific requirements which must be met. If you plan to file for insurance for either screening, please call your insurance company before your appointment. Using the number listed on your card, and after getting the name of the person you are speaking with, ask the following questions: Does my policy cover the following procedures for Diagnosis Morbid Obesity? Initial Medical Nutrition Evaluations (CPT Code 97802) Behavioral Health Psychiatric Diagnosis Interview (CPT Code 90801) Psychological Testing (CPT Code 96101) Do I need a referral or precertification? If yes, how do I obtain this? Am I required to use a preferred provider? If yes, please provide a list of participating providers in my area. If these services are not covered by your insurance company, Saint Clare s offers a discounted self-pay rate for nutrition screenings. This rate is only available to patients without insurance coverage for this service. Please be prepared to pay at the time of service. Bariatric Psychiatric Associates charges for behavioral health screenings. Please be prepared to pay via cash or check at the time of service. If you are not sure if the doctors participate in your insurance plan, please call Bariatric Psychiatric Associates at While the screenings are required prior to weight loss surgery, you do not need to have them at Saint Clare s. If you are making your appointment with anyone other than Saint Clare s and/or Bariatric Psychiatric Associates, please inform the physician s office you are calling that this service is being requested in preparation for bariatric surgery. Please have them forward their report to your surgeon. If your screenings are performed at Saint Clare s, these reports will automatically be sent to your surgeon. Bariatric Surgery Saint Clare s Health System 11

7 Research Studies & Clinical Trials Patients who qualify as participants in a study may be able to access surgical and medical care services at a reduced fee or without charge. With the support of our accomplished surgeons and in an effort to help advance bariatric surgery, Saint Clare s periodically participates in research studies and clinical trials with partners in the healthcare device, equipment, pharmaceutical and other industries. Patients who qualify as participants in a study may be able to access surgical and medical care services at a reduced fee or without charge. Ask a member of The Center for Weight Loss Surgery staff or your surgeon about current studies or trials and whether you may qualify. Saint Clare s Support Groups The Center for Weight Loss Surgery provides free access to support groups for bariatric surgery patients to gain more education and share common experiences with other patients. The Center for Weight Loss Surgery provides access to support groups for bariatric surgery patients to gain more education and share common experiences with other patients. Pre-registration is not required and family members and friends are also welcome. The following support groups are available: Gastric Bypass Support Group This is a free support group for gastric bypass patients. Topics include nutrition following bypass, exercise strategies, emotional issues, holiday management, protein filled recipes and many other issues of interest to the group. Led by registered dietitians, this group meets the fourth Wednesday of each month from 6 p.m. to 7 p.m. at Saint Clare s Hospital/Dover. Gastric Banding Support Group This is a free support group for gastric band patients. Topics discussed include post procedure diet, what to expect at the first adjustment, relaxation techniques, exercise strategies, protein requirements, holiday management and other issues of interest to the group. Led by registered dietitians, this group meets the fourth Wednesday of each month from 7:15 p.m. to 8:15 p.m. at Saint Clare s Hospital/Dover. Please call for more information. For additional support groups in your area, contact the New Jersey Self-Help Group Clearinghouse at FOR-MASH ( ) or visit Bariatric Surgery Saint Clare s Health System 13

8 Frequently Asked Questions How do I know if I qualify for weight loss surgery? If you have tried to lose weight and have failed, and are currently 80 to 100 pounds overweight, weight loss surgery may be an option for you. You may also be a candidate for surgery if you suffer from obesity related health problems such as diabetes, sleep apnea, heart disease, joint disease, infertility or depression. How does weight loss surgery compare with other weight loss programs? Patients will lose significant amounts of weight after the surgery. The surgery works as a tool to help you feel full more quickly, so you will eat less and consume fewer calories. It becomes easier to control your eating and make healthy changes in your diet when you feel full. Traditional attempts at weight loss have been unsuccessful in many people using methods such as diets, weight loss medication, and exercise programs. How much weight will I lose? Most patients experience significant weight loss. Your success will be dependent upon how well you are able to change your eating habits and follow the prescribed program. Are there side effects or complications after the surgery? Your doctor will review potential side effects and complications with you. Nausea and occasional vomiting may occur right after surgery. The doctor will order medication to keep this controlled. Will I be able to drink alcohol after the surgery? It is recommended to avoid drinking alcohol after weight loss surgery since it contains empty calories. After gastric bypass surgery, patients may develop dumping syndrome (sweating, palpitations, cramping and diarrhea) after consuming alcohol due to its high sugar content. How long will it take to recover from the procedure? Your recovery will be dependent upon how quickly your body adjusts. Everyone recovers at a different rate. Speed of recovery also depends upon what other medical problems you have. Will weight loss surgery limit my activity? Once your body has adjusted to the surgery, you will be able to resume your normal activities. Starting an exercise program will improve your success with weight loss and is highly recommended. Your doctor will let you know when you can resume more strenuous activity. Do I need to participate in follow up visits and support groups to be successful? You must change your lifestyle to be successful once the surgery is completed. You will still need to diet and exercise. You must be committed to lifelong follow up with your surgeon, changing your eating behaviors, and taking vitamins to remain healthy. Participating in the support groups will provide you with the education, support and helpful suggestions to make the necessary changes leading to long term success with keeping your weight off. Additional Services Our Center looks after your health and well being from pre-surgical appointments and consultations, through surgery, recovery and lifestyle changes. We are here to help you meet your goals, while maximizing your weight loss and fostering your new found sense of health and wellness. We ll empower you with the tools, skills and behaviors necessary to be successful and support you throughout your weight loss journey. Before and after surgery, as your body and general health changes, you may find the need for other medical support and educational services. Services are available in the areas of sleep medicine, diabetes education and management, women s health and complementary medicine. Contact The Center for Weight Loss Surgery for more information and details on these other available services. Directions The Center for Weight Loss Surgery is located at Saint Clare s Hospital/Dover, 400 West Blackwell Street, Dover, NJ The facility offers easy access and convenient parking. To contact the center by phone, call From Route 80 (Westbound): Take Route 80 West to Exit 35A. Pass the Rockaway Townsquare Mall toward Dover on Mt. Hope Avenue. At the sixth traffic light, turn right onto Route 46 West (East McFarlan Street). Turn left at the fourth traffic light (Elk Avenue). From Route 80 (Eastbound): Take Exit 35 Dover. Follow Mount Hope Avenue to Route 46. At the sixth traffic light, turn right onto Route 46 West (East McFarlan Street). Turn left at the fourth traffic light (Elk Avenue). From Route 46 (Westbound): Stay on Route 46, through the town of Dover, pass Hurd Park on the left. At the next light, turn left to the main entrance of Saint Clare s Hospital/Dover. (This will be at the intersection of Elk Ave. and Rt. 46.) From Route 46 (Eastbound): Stay on Route 46, through the town of Mine Hill and into Dover. Turn right into the main entrance to Saint Clare s Hospital/Dover. (This will be at the intersection of Elk Ave. and Rt. 46.) Important Contact Information Patricia Smith Bariatric Program Coordinator psmith@saintclares.org Pat Kanya, Secretary pkanya@saintclares.org Cheryl Iannicelli, Registered Dietician ciannicelli@saintclares.org Call One Central Scheduling Bariatric Surgery Saint Clare s Health System Bariatric Surgery Saint Clare s Health System 15

9 Saint Clare s Hospital/Dover 400 West Blackwell Street Dover, NJ FAX STCLARE ( ) 11396