Hi from Jen in NC

[JenKapNC]

Hello to all! I've been investigating WLS for the last two months with some veracity. A co-worker had the SIPS/SADI procedure done here in NC and was having great success with it. I was about 3/4 of the way through pre-op procedures when I heard through one of the local support groups that BCBS of NC was going to stop covering SIPS. Ugh. Back to the drawing board.

I've been doing more research and although the vitamin regimen, my reflux issues and past borderline anemia have me a little concerned about the DS, I truly believe it is the best option for me. I know myself and I'm a cut once kind of gal who needs both a restrictive and malabsorptive procedure.

Based on reviews from this website and others I contacted Dr. Sudan's office in Durham, NC about having them do my DS. His nurse was optimistic that they maybe able to use some of my pre-op tests that I have already obtained (all less than 30 days out).

If anyone has any advice or pointers to offer I am all ears.

Thanks in advance for all your support and it has already been my pleasure to get to know some of you through your posts.

Jen
41 with a BMI of 41

 

[newanatomy]

I am so glad to read you are doing your research. Welcome to Bariatric Facts!

 

[southernlady]

Welcome @JenKapNC

Sorry you had to back up but honestly I didn't know that BCBSNC EVER covered the SIPS unless the doctors were playing fast and loose with the codes for it. But, with that said, at least you have a very good option and can easily transfer to a different surgeon.

I'm also in NC (western NC).

 

[JenKapNC]

@southernlady
I'm not sure what they were coding the procedure as... I know that the Dr. had to call and argue the case for SIPS many times with BCBS. I know my policy has a CPT Code for "other laproscopic procedure" and maybe that's what they were using. My co-worker, with the same insurance, just had the procedure completed two months ago by the same Dr. I also know that other insurance companies, including United, and still letting patients go through with SIPS, at least at this office. The Dr. wants me to keep moving ahead... I think in hopes that the insurance issue will get resolved; but I'm not inclined to wait around.

Thanks for the encouragement. I watched a video today of Dr. Sudan explaining his procedure and I really like his methodology. Keep your fingers crossed for me.

 

[Larra]

Hi and welcome!
I'm glad you were able to retrench and find an option that suits you. And frankly, many of us here have wondered whether or not some surgeons have played fast and loose with coding for the SIPS option, using the DS code or some kind of "other" catch-all code. While there is some overlap between SIPS and the DS they are truly not the same operation.
Dr. Sudan has an excellent reputation and a lot of DS experience, so you've made a great choice.

 

[Pacifica]

Hi there! I'm in NC too, same age, same BMI. Sorry to hear about your frustrating experience. I know that there is no current CPT code for the SIPS procedure, and so some surgeons in NC were coding it as 43845 (the DS code) and notifying the insurance company that they would be doing SIPS in the pre-authorization and noting it in the surgical notes. I don't think they were trying to bamboozle anyone, there just isn't a code for SIPS yet, so they were having to make do. For awhile, BCBS of NC was paying for those, but during more recent meetings between the medical directors and area surgeons, it was made clear that they will not continue to do so, and want to see an actual procedure code specific to SIPS before they approve any more.

As I understand it, the ASMBS (surgical association) is going to be meeting on this issue this fall and will likely make a recommendation to the AMA to create a CPT code for SIPS. The insurance companies will reevaluate their corporate medical policies at some time after that. I totally understand why you wouldn't want to wait for all of that to take place, and in any event it looks like you've picked a procedure with a great track record and an excellent surgeon. All kinds of support coming from this corner.

 

[southernlady]

As I understand it, the ASMBS (surgical association) is going to be meeting on this issue this fall and will likely make a recommendation to the AMA to create a CPT code for SIPS.

They FIRST need to decide WHAT to call it...SADI or LoopDS or SIPS.

 

[JenKapNC]

@Pacifica - Thanks for that info. That makes me wonder whether BCBS would approve a CPT code for SIPS within the next six months. Possibly... but considering I've already met my out-of-pocket and I know for a fact that the DS is covered, my gut tells me to proceed along those lines.

@southernlady - According to what I've researched, Dr. Sanchez-Pernaute of Spain conducted the first research of the procedure and refers to it as the SADI. Roslin and Cottam say they standardized the size of the sleeve and the length of the channel and call it SIPS. IMO Cottam and Roslin are just using a marketing scheme to brand the procedure here in the US.

Suggestions on the best place to go on the forum for DS specific meal plans / nutrition / vitamin advice? I'm sure I've just probably overlooked something obvious, but I'm just getting started. Thanks again.

 

[Pacifica]

Agreed, southernlady. Pick a name, right? In the US, my money is on SIPS. SADI was the name given by the surgical contingent from Spain who first developed the idea. According to my surgeon and another surgical PA I spoke to, Spain was seeing some signs of malnutrition with a couple of patients when using a 200 cm channel, so they increased the SADI to 250, and have found the best weight loss/nutrition balance at that length (as I understand it, those patients are 6-7 years out now, and the study is awaiting publication). The surgeons here in the US opted for a 300 cm channel and a different sleeve size. I haven't seen anything on the term LoopDS in the literature so I can't speak to it, but in Spain it is SADI, and in the currently active study in the US, it is SIPS.

 

[Pacifica]

@JenKapNC - I have been wondering the same thing with relation to the timeline, but I agree with you - follow your gut.

 

[southernlady]

Suggestions on the best place to go on the forum for DS specific meal plans / nutrition / vitamin advice? I'm sure I've just probably overlooked something obvious, but I'm just getting started. Thanks again.

Vitamins: http://bariatricfacts.org/forums/vitamins-labs.16/

We really don't have meal plans...we focus on protein first so any menu that has it as its main component is top of the list. We limit carbs...esp simple carbs. And for a DSer, fat is a free food. Each of us figures out what works best but for most of us, carbs are limited.

We do have a section for recipes. http://bariatricfacts.org/forums/recipes.17/

Nutrition, make sure you completely understand what a carbohydrate is. It's not just sugar. It's any food that is not protein (as in cow) or fat (butter).

 

[brooklyngirl]

Welcome! Sounds like you're already on the way to being well informed. Keep reading, there's a boatload of info her

 

[GirlFriday]

Hello and welcome. You will find lots and lots of really good information here. I am only eight weeks out, and I learn new things on this forum all the time. The veterans here will tell you like it is and give LOTS of good information.
Best of luck!