New Patient Information Booklet: Weight Loss Surgery

Transcription

1 Bariatric Surgery, Metabolic & Nutrition Center New Patient Information Booklet: Weight Loss Surgery UNIVERSITY HOSPITALS UH4-CARE UHhospitals.org/WeightLoss 1

2 Table of Contents Bariatric Surgery, Metabolic & Nutrition Center New Patient Information Booklet: Weight Loss Surgery The Process: What Do You Do Next?...3 Body Mass Index Chart (To determine eligibility)...4 Comparison of Surgery Procedures...5 Determining Eligibility for Weight Loss Surgery (What to ask your insurance company)...6 Financial Questions...7 Primary Care Doctor Support Document...8 Medically Supervised Weight Loss Program Schedule...9 Online Questionnaire...10 Psychologist Visit...11 Psychology Resources Informative Websites...14 UNIVERSITY HOSPITALS UH4-CARE UHhospitals.org/WeightLoss 2

3 What Do You Do Next? Thank you for watching the University Hospitals Bariatric Surgery Information Session Video. If you are interested in having weight loss surgery, please follow these easy steps: Verify that your insurance policy will cover weight loss surgery (see pages 6 8). Refer to the Determining Eligibility for Weight Loss Surgery form (page 6). Obtain a referral to see the surgeon from your primary care doctor. Some insurance companies do not require a referral; check with your insurance policy. Fill out the Primary Care Doctor Support Document and send this to your primary care doctor to obtain his/her sign-off (page 8). Begin your medically supervised weight loss program (if your insurance requires this). See enclosed schedule (page 9). Collect any recent medical records from your doctors and bring them to your first surgeon visit. Complete the online questionnaire. This must be completed before your first appointment with the surgeon (see page 10). You will receive a letter from our office instructing you how to begin. Identify a support person. You are encouraged to bring a support person to your first visit with the surgeon. Schedule your psychological evaluation after your surgeon visit (see pages 11 13). UNIVERSITY HOSPITALS UH4-CARE UHhospitals.org/WeightLoss 3

4 Body Mass Index Bariatric Surgery Program BODY MASS INDEX 5'0" 5'1" 5'2" 5'3" 5'4" 5'5" 5'6" 5'7" 5'8" 5'9" 5'10" 5'11" 6'0" 6'1" 6'2" 6'3" 6'4" To qualify for weight loss surgery at University Hospitals: BMI > 35 AND weight-related illnesses OR BMI > 40 To Qualify for Weight Loss Surgery at UH Case Medical Center: BMI > 35 AND weight related illnesses OR BMI > 40 UNIVERSITY HOSPITALS UH4-CARE UHhospitals.org/WeightLoss 4

5 Comparison of Surgery Procedures Gastric Sleeve Adjustable gastric band bypass gastrectomy (lap band) Technique Laparoscopic Laparoscopic Laparoscopic Length of surgery 2 3 hours 1 2 hours 1 2 hours Time in hospital 2 3 days 1 2 days 0 1 day Return to work 3 4 weeks 3 4 weeks 1 week Weight loss 50 75% of excess 50 70% of excess 40 50% of excess body weight at one year body weight at one year body weight at one year Risk of death <1% <1% <1% UNIVERSITY HOSPITALS UH4-CARE UHhospitals.org/WeightLoss 5

6 Determining Eligibility for Weight Loss Surgery What to Ask Your Insurance Company Speaking to your insurance company can be a very confusing process. We have put together an easy-to-follow checklist to help make it easier for you to speak to your insurance company. 1. Call the number on the back of your insurance card. Keep your card on hand during the phone call 2. Tell the representative the following information: I am looking to have bariatric surgery My diagnosis code is: The CPT codes for the surgeries I am interested are: Laparoscopic adjustable gastric band (lap band): Open gastric bypass: Laparoscopic gastric bypass: Laparoscopic sleeve gastrectomy: Ask the representative the following questions: Are these procedures covered by my insurance policy? Lap band: Yes No Open gastric bypass: Yes No Laparoscopic gastric bypass: Yes No Laparoscopic sleeve gastrectomy: Yes No Do I need a referral to see the surgeon: Yes No What is the maximum out-of-pocket dollar amount I must pay per calendar year? Do I have a cap on the amount you will pay for the surgery? Yes No If yes, what is the maximum amount you will pay? Am I required to complete a medically supervised weight management program before I have weight loss surgery? Yes No If yes, how many sessions must I attend? If yes, do these sessions need to be consecutive? Yes No What is the representative s name that you spoke to? What is the confirmation number for today s discussion? Today s date is: UNIVERSITY HOSPITALS UH4-CARE UHhospitals.org/WeightLoss 6

7 Financial Questions If you have any questions regarding the out-of-pocket cost for your surgery, please contact one of our financial counselors. UH Case Medical Center UH Geauga Medical Center UH Parma Medical Center They will be happy to assist you with your financial questions. Notes: UNIVERSITY HOSPITALS UH4-CARE UHhospitals.org/WeightLoss 7

8 Primary Care Doctor Support Document Today s date: is an active patient of mine and is currently being evaluated (Patient Name/DOB) for bariatric surgery at: University Hospitals University Hospitals University Hospitals Case Medical Center Geauga Medical Center Parma Medical Center Euclid Avenue Ravenna Road 6707 Powers Boulevard Cleveland, Ohio Chardon, Ohio Parma, Ohio ; Fax ; Fax ; Fax My patient has the following selected medical conditions (check all that apply): Diabetes Type I Diabetes Type II Hypertension Hypercholesterolemia Sleep apnea Arthritis Infertility Joint pain: location(s): Incontinence Other weight-related conditions: My patient has tried traditional medical weight loss under my supervision and failed. Medical weight loss programs attempted: My patient is currently taking the following medications: It is my belief that this patient would be a good candidate for weight loss surgery. Additional comments: Sincerely, Physician signature: Date: Practice name: _ Practice address: City: State: ZIP: UNIVERSITY HOSPITALS UH4-CARE UHhospitals.org/WeightLoss 8

9 Medically Supervised Weight Loss Program 2015 Join our FREE 1 medically supervised weight loss groups! The Bariatric Surgery Program at University Hospitals is pleased to offer free medically supervised weight loss groups. These groups will assist patients in meeting the preoperative, medically supervised nutrition requirement mandated by insurance companies prior to weight loss surgery. We offer FIVE convenient locations to serve you! UH GEAUGA MEDICAL CENTER Ravenna Road, Chardon, Ohio Conference Center 5:30 6:30 p.m. (Second Tuesday of each month) January 13 February 10 March 10 April 14 May 12 June 9 July 14 August 11 September 8 October 13 November 10 December 8 UH GENEVA MEDICAL CENTER 870 West Main Street, Geneva, Ohio Private Dining Room 4 5 p.m. (Fourth Thursday of each month) January 22 February 26 March 26 April 23 May 28 June 25 July 23 August 27 September 24 October 22 November 19 2 December 17 2 UH PARMA MEDICAL CENTER 7007 Powers Boulevard, Parma, Ohio Nelson Auditorium 5:30 6:30 p.m. (Fourth Wednesday of each month) January 28 February 25 March 25 April 22 May 27 June 24 July 22 August 26 September 23 October 28 November 18 2 December Patients requesting to have their Medically Supervised Weight Loss Group records released to a non-uh facility for any reason prior to their weight loss surgery will be required to pay a $500 program fee prior to record release. 2 Special date for meeting UH CHAGRIN HIGHLANDS HEALTH CENTER 3909 Orange Place, Orange Village, Ohio Third Floor Lobby 5:30 6:30 p.m. (Third and fourth Wednesday of each month) January 21 January 28 February 18 February 25 March 18 March 25 April 15 April 22 May 20 May 27 June 17 June 24 July 15 July 22 August 19 August 26 September 16 September 23 October 21 October 28 November 11 2 November 18 December 9 2 December 16 UH WESTLAKE HEALTH CENTER 960 Clague Road, Westlake, Ohio Conference Room 5:30 6:30 p.m. (Second Thursday of each month) January 8 February 12 March 12 April 9 May 14 June 11 July 9 August 13 September 10 October 8 November 12 December 10 For more information, contact us: University Hospitals Chagrin Highlands and UH Westlake health centers: University Hospitals Geauga and UH Geneva medical centers: UH Parma Medical Center: To see patient stories and learn more about our program, visit: UHhospitals.org/WeightLoss UNIVERSITY HOSPITALS UH4-CARE UHhospitals.org/WeightLoss 9

10 Online Questionnaire 1. After you make your first appointment with the surgeon, you will be sent a letter and an asking you to fill out a mandatory online questionnaire. 2. You will be sent a link that will take you to the online questionnaire. 3. After you click on the link to get into the questionnaire, click on New Patient Registration. 4. Fill in the remaining screens by pressing Next. (Note: Pressing Save before the form is complete will require you to log in again.) 5. The online questionnaire tells the doctor about your health history and must be completed before your appointment with the surgeon. Frequently asked questions: Why do I have to complete this questionnaire? Filling out this form will save time at your surgeon visit and allow you and your surgeon to have a more focused and productive visit. What do I do if I don t have a computer? Use the computer at your local public library. Borrow a computer from a family member or a friend. How long will it take me to complete the online questionnaire? The questionnaire should take you approximately minutes to complete. If you have difficulty answering any questions on the online questionnaire, your physician will be happy to discuss them with you during your clinic visit. I don t know how to use a computer; what do I do? Please contact us for assistance. We can help you complete the questionnaire if you are unable to do so. UNIVERSITY HOSPITALS UH4-CARE UHhospitals.org/WeightLoss 10

11 Psychologist Visit You may schedule your psychologist visit after your appointment with the surgeon. If you have your own psychologist, please feel free to see him or her for your assessment. If you would like to see one of our program psychologists, please directly contact one of the providers listed on the Psychology Resources sheets. Your health insurance may also recommend a provider. Your psychologist must provide us specific information in your evaluation. Please give this form to your psychologist before you begin your visit. Behavioral evaluation must include: 1. Evaluation of psychological history. Specify if past/present issues have been identified and addressed. 2. Current behavioral health treatment including psychiatric medication. 3. Evaluation of any mental health disorders. 4. Evaluation of any eating disorder (past or present). 5. Does the patient have any psychiatric diagnoses that would contraindicate bariatric surgery or lead to a poor prognosis? 6. Is this patient intellectually able to understand the risks and realistic goals of the surgical procedure? 7. Is this patient sufficiently able to understand and adhere to a plan of lifelong behavioral management and dietary management postoperatively? 8. Is the patient committed to long-term follow-up with the physician and dietitian? 9. Statement as to whether or not the patient is an acceptable candidate for bariatric surgery. Additional information that is recommended but not required: 1. History of healthy dieting/weight loss maintenance. 2. Life stressors, past and/or present. 3. Support people. 4. History of alcohol or drug abuse. 5. Is the patient currently a risk to self or others? 6. History of suicide attempts. 7. Past behavioral health treatment of any type. 8. Family history of mental illness. 9. Objective mood assessment. 10. Objective eating assessment tools. 11. Any intellectual, personality, lack of support/family distraction, insufficient motivation, addiction proneness, unwillingness to comply with recommendations that would cause a barrier to successful surgical adjustment? UNIVERSITY HOSPITALS UH4-CARE UHhospitals.org/WeightLoss 11

12 Psychology Resources University Hospitals Jeffery Janata, PhD Euclid Avenue Cleveland, Ohio Sheryl Kingsberg, PsyD Euclid Avenue Cleveland, Ohio Cleveland Eastside Howard M. Bonem, PhD Highpoint Road, Suite B Beachwood, Ohio Engle Road, #201-1 Middleburg Heights, Ohio hbonem@psychbc.com Kenneth A. De Luca, PhD Center Ridge Road, Suite 5 North Ridgeville, Ohio Midway Boulevard, Suite 301 Elyria, Ohio Center Ridge Road, Suite 604 Rocky River, Ohio Euclid Avenue, Suite 5 Willoughby, Ohio Barbara Doremus, PhD 8224 Mentor Avenue, Suite 208 Mentor, Ohio Fax: Debra El-Amin, PsyD 3989 Strandhill Road Cleveland, Ohio John A. Glovan, PsyD 8224 Mentor Avenue, Suite 208 Mentor, Ohio Fax: jglovan@psychbc.com Deborah Koricke, PhD Westgate Professional Center, Suite 200 Fairview Park, Ohio Chagrin Boulevard, Suite 104 Beachwood, Ohio Fax: Rakesh Ranjan, PhD 5010 Mayfield Road Cleveland, Ohio Elaine S. Revis, PhD Chagrin Boulevard, Suite 310 Beachwood, Ohio elainerevis@aol.com Deborah L. Ross, PhD 1450 SOM Center Road, #22 Mayfield Heights, Ohio George Steckler, PhD 8224 Mentor Avenue, Suite 208 Mentor, Ohio Fax: Cleveland Westside Alf Bergman, MD 6115 Powers Boulevard, #204 Parma, Ohio John Bertschler, PhD 8040 Corporate Circle, #4 North Royalton, Ohio Howard M. Bonem, PhD Highpoint Road, Suite B Beachwood, Ohio hbonem@psychbc.com 7055 Engle Road, #201-1 Middleburg Heights, Ohio Kenneth A. De Luca, PhD Center Ridge Road, Suite 5 North Ridgeville, Ohio Midway Boulevard, Suite 301 Elyria, Ohio Center Ridge Road, Suite 604 Rocky River, Ohio Euclid Avenue, Suite 5 Willoughby, Ohio Michael Faust, PhD 1730 West 25th Street, #444-A Cleveland, Ohio Clint Felker, PhD 5851 Pearl Road, #308 Parma Heights, Ohio Antone F. Feo, PhD Center Ridge Road Building 2, Suite 100 Westlake, Ohio afeo@afeophd.com Hillary Hassinger, PhD 1730 West 25th Street, Suite 4E Cleveland, Ohio Greg Keck, PhD State Road, Suite 1 North Royalton, Ohio Anita Maximin, PsyD Sprague, Suite A Strongsville, Ohio Center Ridge Road, Suite 610 Rocky River, Ohio UNIVERSITY HOSPITALS UH4-CARE UHhospitals.org/WeightLoss 12

13 Psychology Resources (continued) Eastern Ohio Patricia Firem, PhD 401 South St. Chardon, Ohio Stacey Foerstner, PhD Chardon Rd., #202 Willoughby, Ohio Margaret Lahner, PhD 8825 Mayfield Rd. Chesterland, Ohio Zinaida Lebedeva, MD 8825 Mayfield Rd. Chester Township, Ohio Dennis Pinciotti, PhD, LPCC Aurora Rd., #270 Solon, Ohio Albert M. Pondillo, PhD 1704 North Rd., SE Warren, Ohio Western Ohio Darlene J. Barnes, PhD, APRN, BC 503 Garrison St. Fremont, Ohio Robert W. Daniels, PhD 1617 W. Bogart Rd. Sandusky, Ohio Kenneth A. De Luca, PhD Center Ridge Rd., Suite 5 North Ridgeville, Ohio Midway Blvd., Suite 301 Elyria, Ohio Center Ridge Rd., Suite 604 Rocky River, Ohio Euclid Ave., Suite 5 Willoughby, Ohio Indira Palekar, PhD 436 East River St., #5 Elyria, Ohio Thomas F. Zeck, PhD 1740 Cooper Foster Park Lorain, Ohio Southern Ohio David Gannon, PhD, LPCC 4572 Dressler Rd., NW Canton, Ohio Paul Vajner, PhD 696 East Washington Medina, Ohio Central Ohio Dennis A. Markis, PhD 788 Lexington Ave. Mansfield, Ohio mariki@aol.com UNIVERSITY HOSPITALS UH4-CARE UHhospitals.org/WeightLoss 13

14 Informative Websites Below you will find several websites that you might find useful to you as you search for more information on weight loss surgery. These sites are for informational purposes only; any medical questions should be directed to your physician. Bariatric surgery web resources UHhospitals.org/WeightLoss University Hospitals website for weight loss surgery Resource for bariatric recipes, food items and patient support A national health publication and online support platform dedicated to providing inspiration, education, guidance and support for anyone struggling with obesity or maintaining a healthy weight Interactive website for patients in all stages of the weight loss surgery process A website dedicated to educating patients on the laparoscopic adjustable banding procedure Active at any size Helps overweight patients increase their physical activity Bariatric surgery for severe obesity A review of the different weight loss surgeries available to patients Excellent resources for obesity law and health care matters American Society for Metabolic & Bariatric Surgery Among the nation s leading academic medical centers, University Hospitals Case Medical Center is the primary affiliate of Case Western Reserve University School of Medicine, a nationally recognized leader in medical research and education University Hospitals DHI UNIVERSITY HOSPITALS UH4-CARE UHhospitals.org/WeightLoss 14