Bariatric (Weight Loss) Surgery Center of Excellence at MUSC : Preparing for Bariatric Surgery : Steps to Weight Loss Surgery

Step 1a: Call MUSC Health Connection at 843-792-1414 to register for "Risks and Benefits of Bariatric Surgery" lecture.

             OR

Step 1b: View the video online and take a test to verify your understanding of the
             Facts About Weight Loss presentation

Step 2: Complete Patient Information Packet and send in to the obesity surgery 
            center at MUSC

Step 3: Verify Insurance Coverage for Weight Loss Surgery

Step 4: Medical Qualification for Weight Loss Surgery

Step 5: Phone Interview with dietitian at obesity surgery center

Step 6: Psychologist Interview and Evaluation

Step 7: Surgeon Interview and Evaluation at obesity surgery center

Step 8: Acquiring Insurance Approval

Step 9: Attend Mandatory Nutrition Class

Step 10: Scheduling the Surgery Date and Pre-Op Visit

Step 11: The Surgery

Step 12: Follow up visits

STEP 1:  Call MUSC HealthConnection at 843-792-1414 to register for "Risk and Benefits of Bariatric Surgery" lecture or view the videos online.
The first step in your process of evaluation for weight loss surgery is to attend a one hour lecture on the facts about weight loss surgery.  This informative session presented by the Program Manager, Dietitian and Surgeon will give you the necessary information to decide if weight loss surgery is something you want to pursue.  At this session, you will receive a folder of information and forms for you to fill out and return to the Bariatric Surgery Program if you decide to pursue surgery.  If you take the quiz online, a packet will be mailed to you.

STEP 2:  Complete the Patient Information Packet and return to the MUSC Bariatric Surgery Program Office.
Please complete all sections of the packet.  Do not leave any sections blank.  If a section does not apply to your situation, please state “does not apply.”  If you are unsure of dates, please use approximate dates and durations for the diet history.  The information you provide is very important in helping us learn more about you, your general health and weight control issues.  Our goal is to provide you the highest quality of care tailored to meet your health needs.

IMPORTANT:  When you have completed your Initial Patient Information Packet, please mail it to:

Bariatric Surgery Program Office
Medical University of South Carolina
25 Courtenay Drive, ART 7100A
MSC 290
Charleston, SC  29425-2270

STEP 3: Insurance Coverage for Weight Loss Surgery
Please contact your insurance company and verify that your policy does cover weight loss surgery!  Ask your insurance company if the following procedures are covered at the Medical University of South Carolina by your insurance plan:

Roux-en-Y gastric bypass (CPT Code 43644)
Laparoscopic Adjustable Gastric Band (CPT 43770)

A VERY IMPORTANT NOTE: Most insurance companies require the following:

• medical documentation of a five-year weight history
• any actual documentation of diet drugs and medically supervised diets prescribed
• any commercial diet program records (Weight Watchers, Jenny Craig, etc.)
• any exercise program records (YMCA/YWCA, Gym membership, etc.).

You will need to begin gathering these records NOW so that these are available when we communicate with your insurance company.  It is NOT enough for you to simply list these items on the initial patient worksheet questionnaire.  The insurance company will require official documentation.

STEP 4: Medical Qualification for Weight Loss Surgery
Once your Initial Patient Information Packet is received in our office the packet will be evaluated by our staff to determine if you qualify for weight loss surgery according to the National Institutes of Health guidelines.  The current guidelines are:

• BMI > 40, or
• BMI > 35 with weight related comorbidities such as high blood pressure, high cholesterol, obstructive sleep apnea, diabetes mellitus, osteoarthritis, gastroesophageal reflux, AND
• have failed previous attempts at weight loss through non-surgical means

Calculate your BMI. The information in your packet may also reveal other medical problems which could require evaluation by other specialists. If you do not meet the criteria for weight loss surgery you will be contacted to discuss non-surgical options.

STEP 5: Dietitian Phone Interview
Once your initial patient information packet has been reviewed, you will receive a call from our Registered Dietitian to do a telephone interview with you.  It is important that you indicate in your packet a time of day and day of week during normal business hours that you are generally available to have this conversation.  You will not proceed forward in the steps to surgery until this phone interview is completed.

STEP 6: Psychologist Interview and Evaluation
The dietitian will schedule you to be evaluated by our psychologists in their office on Daniel Island.  They hold office hours on Tuesday mornings.  Our clinical psychologists are specially trained in evaluation of patients for weight loss surgery and working with patients in a medically managed weight loss program. They will review the psychological assessments tools you completed with your initial packet of information and conduct a one-on-one interview with you.  They will then make a recommendation to us on their assessment of your ability to be successful with the surgery.

STEP 7: Surgeon Interview and Evaluation
Please prepare for this visit by:

1. Reviewing all material provided to you.
2. Bringing a list of your questions and a pen or pencil.
3. Bringing a family member with you who will be your support system post operatively.

At this visit you will meet with your surgeon who will conduct a physical exam to determine your surgical risk.  At this time you will also discuss the procedures that are reasonable for you, and expected outcomes.  You will also meet with a dietitian at this visit to develop dietary goals prior to surgery.

STEP 8: Acquiring Insurance Approval
After your initial consultation with the dietitian, psychologist, and surgeon, all documentation of your weight history, diet and exercise programs plus other records will be compiled and we will submit a letter of recommendation to your insurance carrier requesting approval for surgery. Your medical records are forwarded to your insurance company with this letter.  The insurance company will let us know if there is any additional information they will need to make the decision to approve or deny your surgery.  Again, as described in Step 3, having your weight and weight treatment history at this time is very important.  Failure to include this information may result in a delay of the decision for approval or a denial for insurance coverage.

Some insurance companies will make the decision about your surgery within a few weeks.  Some insurance carriers take several weeks or months to return a decision.  We will contact you when we have heard from your insurance company.  You may contact your insurance company to check on the status of your insurance approval.

STEP 9: Attend Mandatory Nutrition Class
You are required to attend a mandatory nutrition class prior to your pre-operative workup.  The classes are specific to the Laparoscopic Adjustable Gastric Band and to Gastric Bypass.  Please make sure you attend the class appropriate to the procedure you will be having. 
Bariatric Surgery Nutrition Class Schedule

STEP 10: Scheduling the Surgery Date and Pre-op Clinic Visit
Once your insurance approval is obtained, you will be provided with a pre-operative clinic appointment and a date for surgery.  At your pre-operative visit you will meet with a physician and/or nurse practitioner who will obtain your medical history and perform a complete physical exam. You also meet with your surgeon who will review all aspects of your upcoming surgery and review your surgical consent form.  You will also meet with the dietitian to assure that you don't have any last minute questions or concerns.

STEP 11: The Surgery
In most cases you will be admitted to the hospital the morning of surgery.   The actual time you will need to arrive will not be known until the day before surgery.  You will be in the hospital for 2-3 days.  We recommend that you arrange to have a friend or family member stay with you while you are in the hospital. 

STEP 12: Follow-up Visits
Bariatric Surgery is one in which we expect to have a lifelong relationship with you and we look forward to working with you and watching your progress with your weight loss. Compliance to a follow up schedule is critical to a successful outcome.  Your required follow up visit pattern after surgery is as follows:

For gastric bypass:

Within 5-10 days post-op

• Jackson Pratt Drains will be removed at this visit for patients done laparoscopically
• Physician Exam
• Dietitian Evaluation, as needed

One month post-op

• Physician Exam
• Dietitian Evaluation, as needed

Every three months post-op for a year

• Physician Exam
• Dietitian Evaluation, as needed

Every six months for a year – labs checked at six month intervals then annually

• Physician Exam
• Dietitian Evaluation, as needed
• Labs

Annually for life

• Physician Exam
• Dietitian Evaluation, as needed
• Labs

For LAP-BAND:

Every month post-op for a year

• Physician Exam
• Dietitian Evaluation, as needed
• Weight loss evaluation and possible adjustment to the band

Annually for life

• Physician Exam
• Dietitian Evaluation, as needed

STEP 13: Follow-up Resources
Bariatric surgery is just the tool to help you with your weight loss.  In order to help you be as successful as possible, we have developed several resources to support you in your journey.  We encourage you to take advantage of them fully!
 Classes and resources.