Dear Gastric Bypass Patient

Surgical Group of Gainesville’s physicians and assistants, (Jeff Rose MD, Peter Sarantos MD, Bruce Brient MD, Timothy Hipp MD, and Linda McMahon CST\CFA) welcome you and wish to provide you with important information regarding your decision to have gastric bypass or lapband surgery. This letter will answer frequently asked questions regarding your bariatric procedure. Please read this information carefully and completely before you contact us regarding additional information. All this information is also available on our web site at www.sggonline.com for your convenience.

Who Is Surgical Group Of Gainesville?
Surgical Group of Gainesville is a group of seven general surgeons. Four of these surgeons (Dr. Jeff Rose, Dr. Peter Sarantos, Timothy Hipp MD and Dr. Bruce Brient) have a special interest in bariatric surgery. Together they have over thirty years of experience performing gastric bypass for the treatment of morbid obesity.

The Surgical Group of Gainesville has partnered with North Florida Regional Medical Center to provide you with the necessary support to make this surgery successful for you. This partnership brings together the surgical expertise of the Surgical Group of Gainesville and the clinical as well as dietary expertise of North Florida Regional Medical Center. All preoperative as well as postoperative visits will be scheduled at the Center for Obesity Surgery and Treatment. This center which is owned and operated by North Florida Regional Medical Center and is not financially affiliated with Surgical Group of Gainesville.

Your surgery will be done at North Florida Regional Medical Center. All postoperative visits will be at the Center for Obesity Surgery and Treatment. Typically you will be followed at the clinic for eighteen months following your procedure. At that time you will be referred back to the care of your primary care physician. Should any non-surgical medical problems arise during this eighteen-month period we may ask that your primary care physician assist in the management of these issues. Should you require surgical evaluation or treatment after you are discharged from the Center for Obesity Surgery and Treatment we may ask that you be seen at the Surgical Group of Gainesville’s primary office.

How Long Do I Have To Wait?
Every attempt will be made by our office staff as well as the staff at the Center for Obesity Surgery and Treatment to schedule both your initial consultation as well as your surgery in a timely fashion. We certainly have no reason to delay or stall this process. Unfortunately the surgical treatment of morbid obesity is scrutinized very closely by most, if not all commercial insurance carriers. As you are aware many will not cover these procedures at all, those that do will do so only after meeting very specific criteria.

We highly recommend that you contact your insurance provider to verify that your insurance covers obesity surgery.

If you belong to an HMO or are planning to see us “out of network” we will more than likely need an authorization from your primary care physician for your initial consultation. If you are seen without an authorization your insurance provider will more than likely deny your visit and you will then become personally responsible for payment. It is up to you to obtain these authorizations.
Be aware that an authorization for an initial consultation with the surgeon does not guarantee that your insurance company will authorize the surgery.

Prior to your initial consultation we will need several pieces of information that most insurance companies now require in order to process your request for surgery. It is anticipated that once we have the needed information that an initial office visit can be scheduled within four weeks. It may take another four to six weeks after your initial consultation before you actually have surgery.

What Information Do I Need To Give To Surgical Group Of Gainesville Before My First Visit?
In order to receive approval for gastric bypass surgery, it has been our experience that most insurance carriers require certain information before they will even begin the review process. You will need to provide Surgical Group of Gainesville with copies/proof of the following information for submission to your insurance carrier before we will schedule your first visit with the surgeon of your choice:

1. AUTHORIZATION: As discussed above if you are a member of an HMO or are seeing us “out of network” you will need prior authorization. Your primary care physician should assist you with this referral authorization. Keep in mind that future visits, over the eighteen months after surgery, may require authorization as well. Again, your primary care physician should assist you in obtaining this. Failure to do so may result in personal liability for payment. Sample Approval Request

2. TSH: Hypothyroidism is considered by some to be a correctable cause of obesity. Most insurance providers require documentation of a normal TSH (thyroid stimulating hormone) prior to even considering your request for surgery. This lab study can be obtained through your primary care physician.

3. SUPPORTING PHYSICIAN: A letter from your primary care physician supporting the medical necessity for the surgery. This letter should also document at least a six-month attempt and failure of significant weight loss under the direction of a physician.

4. LONG TERM PROBLEM: A documented weight from five years ago. This is usually obtained from a copy of your medical records from your primary care physician from five years ago.

5. PSYCHOLOGIC EVALUATION: A psychological evaluation indicating you are appropriately motivated and have realistic expectations regarding the outcomes of the surgery. Sample Psych Evaluation

6. COPY OF YOUR INSURANCE CARD: (Without this we are unable to verify your insurance benefits.)

In order to assist you in acquiring all this information before your initial consultation we have included two sample letters that you may want to give to your primary care physician and your psychologist/psychiatrist. Theses letters are intended as a guide as to what insurance companies are looking for with regards to medical necessity.

Your first visit with the surgeon is only a consult. It is designed to further inform you and your family of the risks and benefits of this type of surgery, and most importantly to determine if you are a candidate for this type of surgery. Again, a consult does not guarantee that the surgeon or your insurance company will consider you a candidate for surgery. Upon the doctors and your decision to move forward with the surgery process, he will then send a letter to your insurance carrier requesting an approval for surgery. This request may take up to thirty days before we receive a reply from your carrier. Sometimes we will ask you to provide additional information to your insurance carrier and even to contact them regarding delays in the approval process.

When we have received approval from your insurance carrier for surgery and all financial arrangements have been met, then your surgery will be scheduled based upon a first come first serve basis. The Center for Obesity Surgery will contact you with your surgery date and arrange pre-operative visits and testing if necessary.

How Much Is It Going To Cost Me?
This procedure can easily cost over $50,000 when you include your hospital charges. That is why it is very important that the proper approvals be received from your insurance carriers before each visit and each provider you see. You will have to make financial arrangements for each physician visit, your surgeon fees, and your assistant surgeon fees to Surgical Group of Gainesville. In addition you will have to make separate financial arrangements with the Center for Obesity Surgery and Treatment for office visits, North Florida Regional Medical Center for your time in the hospital, anesthesiologists for your surgery, radiologists, as well as specialists if needed.

Please note that each of these providers may or may not accept your insurance. Surgical Group of Gainesville will not be held responsible for any patient charges or fees that occur from these other providers. It is your responsibility to arrange payments with the individual providers. All your deductibles and co-payments must be met or payment plans arranged with our financial counselors before we will schedule your surgery. Medicare recipients must go through an additional approval of payment process after your surgery is completed before we know if Medicare will pay for your surgery. If for any reason your insurance provider does not cover our fees you will assume personal responsibility for those charges.

Who Do I Contact With Additional Questions And Whom Do I Send This Information To?
Your contact at Surgical Group of Gainesville is Shirley Vaughn. Her phone number is (352) 331-1201 ext. 1025. Her mailing address is Surgical Group of Gainesville 1143 NW 64th Terrace Gainesville, Fl 32605. We recommend you mail all of your completed information together in one package. You can also fax all of the completed information together to Shirley at (352) 331-5273. If you fax this information please call Shirley and confirm that we have received it. Once Shirley has verified the completeness of your information she will then contact the Center for Obesity Surgery and Treatment to schedule your initial visit.

The Center for Obesity Surgery and Treatment will also request medical information from you and require authorizations and referrals for visits to their center. Remember all your visits will be conducted at the center and their staff will assist you with information about North Florida Regional Medical Center and the scheduling of your office visits and surgery once all the required information has been received and processed by Shirley Vaughn at Surgical Group of Gainesville. Your contact at the Center for Obesity Surgery and Treatment is Terry McKenzie RN. Her phone number is (352) 331-5255.

How long will I be out of work?
Gastric bypass surgery is major abdominal surgery. As such it is not unusual to be out of work for as long as six weeks after your procedure. We have on rare occasion had patients, who’s job allowed, return as early as two weeks after surgery but this is the exception rather than the rule. From a medical standpoint, if there has been no postoperative complication, there should be no reason to be out of work more than six weeks. We will warn you that you are on a “crash diet” therefore you will feel fatigued, but this is not a medical reason not to return to work.

You will be provided with a medical release form for your employer from the Surgical Group of Gainesville. If your employer requires any further paperwork for clarification, or if other disability forms, credit card forms, or special requested forms need to be filled out we will assist you with this but at a nominal charge per form.

If you anticipate any special circumstances that would require a medical leave of absence of more then six weeks, let your surgeon know prior to your surgery.

Download this form as a MicroSoft Word document. Gastric Packet