VSG to DS Complete; Insurance Denied; Hospital; Eating Food; 4 Days Out; Questions!

[Stefanie S.]

I'm back among the living and my first order of business is to thank all of you! I did go into this surgery informed, confident, and aware that the medical field (particularly dietitians) are not up to speed for DS surgeries. A few notes and questions...

Insurance Denied Twice
But my mom from Kansas had already flown to NC when I got the 2nd denial, which btw was told to me at 3:30pm on the day before my surgery. We made the decision to scramble and put the required fee on 6 different credit cards! I had to pay $20,000 to hospital, $9,000 for surgeon fee, and $2300 to the anesthesiologist. And they all wanted it paid in full up front. I will owe more too because that $20,000 only paid for 2 hospital nights. My questions...

1. Will insurance be billed anyway? So that I can get any insurance discounts? I have BCBS of NC.
2. Dr Sudan (my surgeon) wants to submit it to insurance again. Their last reason was lack of sufficient documentation of compliance to VSG surgery. Any advice on what to submit to meet this requirement? I have copied 12 food logs sampling over the last 3 years. My mom wrote a letter to attest to my exercise as we usually walked, swam,and worked out together. I'm at a loss for what else to provide.
3. How does the hospital charge their "per day" fee? Is it by day or by number of nights? So I had to arrive at the hospital on Tuesday at 9:30 am to check-in for surgery. I was released at 12:00 noon on Friday. So that was a part of 4 different days, but only 3 nights. I understand it was around $10,000 per night, so I'm wondering how much more to expect to be billed for... and how many more credit cards to apply for (ha!)

Hospital Notes

1. Though I was prepared for 4 hours, my surgery only took 1 hour, 45 minutes. I don't know all of my numbers, only that my common channel is 100 cm. My stomach was not re-sleeved. My gallbladder was removed. My small hiatal hernia was left alone.
2. Coming out of surgery into the recovery room was a NIGHTMARE. I was in incredible pain and the recovery nurse was ridiculously uncaring and rude. I was moaning in pain and telling her it hurt. She told me to be quiet because there were lots of other patients around me. Then I kept getting woke up by this loud beep, and she would come firmly say, "BREATHE". After a while, she said, "See, now I've over-medicated you and you stop breathing." I don't know how, but I was coherent enough to say "Can I have my CPAP machine?" She said "You didn't tell me you had a CPAP!" Then I heard her tell someone that I didn't tell her until way late about my CPAP. ARE YOU KIDDING ME? Yes, it is surely my job to come right out of surgery and make sure the nurse is aware that I have a CPAP! It is all over my chart, right? I have seen it. How was this not known?
3. Once I got to my room, the nursing staff at Duke Regional was phenomenal and very caring. Most seemed quite knowledgeable about bariatric surgery.
4. So DS patients aren't allowed to even drink clear liquids until you pass gas! That didn't happen for me until mid-afternoon on Thursday, so 48 hours later. Talk about dry mouth

Drinking Fluids Easy; Eating Real Food

1. Once I started drinking, I was told to VERY slowly sip 1 oz of liquid every 15 minutes. But the weird thing was that I felt like I could handle drinking an entire bottle of water. I suppose that's because my stomach was untouched this time? I did take it slow all day Thursday and Friday, but today, I am drinking pretty normally with no issues. Getting in my hydrating fluids is not an issue.
2. So I'm also supposed to get in at least 60 g of protein (according to NUT), so I am drinking Premier Protein at 30 g each. They taste good enough, but they don't seem to sit well with my stomach. My stomach feels sour afterwards. Thoughts on that?
3. I also feel VERY constipated. Took Miralax at 4:00am today, but nothing still. I feel so super bloated and my stomach is sour, along with a foul taste in my mouth. Is all of this normal?
4. I researched constipation for DSers (on this board!) and I see that fat is my answer! But I'm told not to eat real food until Feb 7, which is 2 weeks after surgery. Eek, that was easy to do when my VSG was done, but I'm already feeling an occasional hunger pang and food sounds so good (again, very different from first surgery). I keep wondering if a very mashed up egg would be okay to eat? Or some full-fat cottage cheese? Maybe some full-fat refried beans? Would that get things moving? Or is this too dangerous?

Nutrition Class / Vitamins

1. I feel frustrated that I had to sit in the same pre-op class (4 days before surgery) as all of the sleeve and RNY patients. I was the only DSer. I was given the same directions of low-fat, very low calorie, and vitamin regimen as everyone else. Thank goodness I had already found all of you! But I also admit that it presents a conundrum as I like to be very open and brutally honest with what I'm doing so that the medical experts can really know what they are dealing with and provide the best help. But if I do that in this situation, I will be labeled as non-compliant. It's a weird position to be in and I am shocked that an entity as advanced as DUKE is still so behind.
2. Last comments on vitamins before I begin my massive ordering? I'm leaning towards vitalady's pre-packaged option so I don't have to figure it all out, but if you have something simpler or feedback, I would be forever grateful!

4 Days Out

1. So I'm exactly 4 days out and I am not in any pain. Haven't had a pain med for 36 hours.
2. I am constipated though and the pressure is uncomfortable.
3. I weighed this afternoon and I am 2 pounds heavier than the day I went into the hospital. I find this odd since I haven't had food for 5 straight days now (includes pre-op day of liquids only.) I know we were told this would happen. Does anyone know the reasoning behind this?
4. Walking really is my best friend, and it's been surprisingly easy this whole time. I was walking the night of my surgery. I walked every chance I got. Laying in bed made my back hurt, so I had extra motivation!

So I'm glad the surgery is done and I'm anxious to start this journey. I'm grateful you all are on this walk with me. I know this is a very long post. If you have a thought or advice on even 1 small item on this post, I am just eagerly awaiting any feedback! My mind is a whirlwind and I'm just trying to figure it all out

Cheers,
Stefanie

 

[harrietvane]

Welcome to the dark side!

I didn't have a BM until about a week after surgery, though I didn't have any discomfort. Re gaining weight, it's from your IV fluids, I imagine!

And good luck on getting your insurance issues settled. I know that @DianaCox and @Larra are the insurance gurus around here, and can probably offer advice on appealing your denial.

 

[harrietvane]

Oh, Vitalady was out of stock on a lot of things for the pre-packaged stuff with a two month delay last time I checked. Honestly, I would try to work up to the vitamins, and don't worry too much about taking things in too many doses - many of us just do twice a day until your blood tests show a reason to do otherwise. Protein is the focus - 30g by 30 days, 60g by 60 days etc. You will hopefully have an easier time given that your stomach wasn't touched!

 

[DianaCox]

I'm only going to address a couple of issues.

Insurance - once you got a denial, your appeal rights were vested. You had every right to self-pay and continue your appeals afterwards. I doubt that the hospital will bill your insurance company when you were self-pay and denied. But tell all the providers (doctors, hospital, pharmacy, pathology, lab, etc.) that you need detailed billing statements, and that you are appealing the denial, so you (1) reserve the right to challenge the bill after the completion of the appeals; (2) remind them that you have the right to be reimbursed the amount of money you paid in excess of the BCBS reimbursement minus your deductible/copay, if you win your appeals.

Vitamins: Order them now if you want, but you may want to wait 2-4 weeks before trying to take them, until your guts are more healed. You can live off the stored vites for a bit. I think Vitalady's plan is overkill myself, especially for newbies. I'd stick to a good quality prenatal, calcium citrate (2 doses/day), magnesium citrate, chewable C (500 mg twice a day), and anything you were low on before surgery (e.g., D3 if needed). Retest at 6 months and see if you need anything else.


Weight: stay off the fucking scale - it is utterly meaningless right now. You were pumped full of IV fluids; you're going to piss them away, and then you're going to lose a couple of pounds of glycogen plus 8 lbs more of water, so your weight is going to go down, then back up, then go down again. STAY OFF THE SCALE.

 

[nedsmehlp]

Stefanie, I am so glad to hear you are done with your surgery and everything is okay. Please post as much as you can about all your experiences. I am hoping to have the revision from VSG to DS within a few months. I am really scared and nervous, so everything you have to say will be greatly appreciated. Also I am anxious to hear how well weight loss is when it is a revision from VSG to DS, I've heard it's much slower. Good luck, hope you continue to heal and feel better. Keep posting or PM me.

 

[southernlady]

Welcome to the Dark Side @Stefanie S.

Sip, walk, rest repeat. And do as @DianaCox suggests as far as getting reimbursed for this.

 

[KathrynK]

I am in awe of your dedication to overcome all of the obstacles to get the DS. About the recovery nurse, please consider writing a letter to the hospital administrator describing your experience. There are great nurses in the world, but there are also people who should not be nurses. You could be helping future patients, but you are also documenting substandard care.

 

[galaxygrrl]

Welcome to a better life.

Good luck with the insurance!

 

[Larra]

Congratulations! In spite of all the last minute crap that went down, you went forward with your DS. Good on you!

I have nothing to add to Diana's advice on the appeal, but want to throw in my agreement with @KathrynK on writing a letter to the hospital admin about your experience in the recovery room. The nurse should have been aware that you were on CPAP, it is most definitely NOT the responsibility of a patient coming out of general anesthesia to provide her nurse with her medical history. And she should have recognized that your moaning was a sign of pain or distress and not deliberately loud behavior. And dealt with it!

 

[Mermaid]

Congratulations!
Sorry your nurse was a witch, glad you're doing pretty well other than the constipation.

Insurance: I don't know your exact denial notes but mine has a similar denial to insufficient proof of my mandatory 6 month diet. It turned out they wanted a detailed letter from my surgeon saying that he has read all my nutritionist office visit notes and that he felt (based only on the notes) that I was compliant and likely to be successful.
@DianaCox and @Larra helped me pre-write his letter for him. He signed it onto his own letterhead and submitted it.
After 4 months of Appeals I was approved within 4 days of them receiving the letter. Remember: this was a compliance letter from the surgeon, who did not supervise my diet in any way. He just signed the cover letter to my compliance notes and food logs.
I can share a copy of the letter with you if you think it sounds helpful. Diana and Larra helped make it a work of art.

 

[hilary1617]

Congratulations on a successful procedure and glad you went for it despite the denial! Please stay hydrated - that really helps with recovery.

P.S. For other readers, who may be pre-op, my surgeon required that I bring the machine with me all the way into the operating room. They added a connector device that allowed them to run oxygen through it (vs. air). Please bring yours to the hospital. You will need it!

 

[Stefanie S.]

Oh, Vitalady was out of stock on a lot of things for the pre-packaged stuff with a two month delay last time I checked. Honestly, I would try to work up to the vitamins, and don't worry too much about taking things in too many doses - many of us just do twice a day until your blood tests show a reason to do otherwise. Protein is the focus - 30g by 30 days, 60g by 60 days etc. You will hopefully have an easier time given that your stomach wasn't touched!

Thank you for the heads up on vitalady. I've been really stressing over the vitamins.

 

[Stefanie S.]

I'm only going to address a couple of issues.

Insurance - once you got a denial, your appeal rights were vested. You had every right to self-pay and continue your appeals afterwards. I doubt that the hospital will bill your insurance company when you were self-pay and denied. But tell all the providers (doctors, hospital, pharmacy, pathology, lab, etc.) that you need detailed billing statements, and that you are appealing the denial, so you (1) reserve the right to challenge the bill after the completion of the appeals; (2) remind them that you have the right to be reimbursed the amount of money you paid in excess of the BCBS reimbursement minus your deductible/copay, if you win your appeals.

Vitamins: Order them now if you want, but you may want to wait 2-4 weeks before trying to take them, until your guts are more healed. You can live off the stored vites for a bit. I think Vitalady's plan is overkill myself, especially for newbies. I'd stick to a good quality prenatal, calcium citrate (2 doses/day), magnesium citrate, chewable C (500 mg twice a day), and anything you were low on before surgery (e.g., D3 if needed). Retest at 6 months and see if you need anything else.


Weight: stay off the fucking scale - it is utterly meaningless right now. You were pumped full of IV fluids; you're going to piss them away, and then you're going to lose a couple of pounds of glycogen plus 8 lbs more of water, so your weight is going to go down, then back up, then go down again. STAY OFF THE SCALE.

Thank you for all of this! I promise to avoid the scale for a while what dosage of calcium, magnesium, and D3 do you intake? And thank you for the insurance advice.

 

[Stefanie S.]

Stefanie, I am so glad to hear you are done with your surgery and everything is okay. Please post as much as you can about all your experiences. I am hoping to have the revision from VSG to DS within a few months. I am really scared and nervous, so everything you have to say will be greatly appreciated. Also I am anxious to hear how well weight loss is when it is a revision from VSG to DS, I've heard it's much slower. Good luck, hope you continue to heal and feel better. Keep posting or PM me.

I sure will! And you are making a great decision!

 

[Stefanie S.]

Congratulations!
Sorry your nurse was a witch, glad you're doing pretty well other than the constipation.

Insurance: I don't know your exact denial notes but mine has a similar denial to insufficient proof of my mandatory 6 month diet. It turned out they wanted a detailed letter from my surgeon saying that he has read all my nutritionist office visit notes and that he felt (based only on the notes) that I was compliant and likely to be successful.
@DianaCox and @Larra helped me pre-write his letter for him. He signed it onto his own letterhead and submitted it.
After 4 months of Appeals I was approved within 4 days of them receiving the letter. Remember: this was a compliance letter from the surgeon, who did not supervise my diet in any way. He just signed the cover letter to my compliance notes and food logs.
I can share a copy of the letter with you if you think it sounds helpful. Diana and Larra helped make it a work of art.

That would be great!