Anyone reading this that has Horizon Blue Cross of New Jersey may
have run into difficulties getting an approval because Blue Cross
recently mandated that they would not approve benefits for weight loss
surgery unless a patient had a five year history of morbid obesity. I
believe I have discussed this in previous newsletters and how absurd it
is. Well we have heard that Blue Cross may reverse this policy,
but they will continue to require patients do a 6 month pre operative
program. This hasn't been confirmed yet but I am keeping my fingers
crossed. If you have any questions about how this will affect you
personally you can email Dominga at dominga@gsbwc.com
. If you are required to do a 6 month program I have started offering
this thru the office. It means you would meet with either me, Joan (my
Physician's assistant), or a nutritionist once a month for 6 months.
This should meet the insurance company's requirements for the pre
operative program. You can call the office, or email Dominga to find if
you need to do the six month program. If you do it is best if you do it
thru my office as sometimes patients who have used their Primary Care
Doctors ended up having problems with proper documentation and then
getting a denial from the insurance company.
If you are someone who has been to the office but hasn't had surgery
yet and is still "thinking about it", I would recommend you make up
your mind soon. Many employers are eliminating benefits for weight loss
surgery from their health care policies. This is a short sighted
attempt to save money but they are doing it anyway. If you have the
benefit in your policy you should take advantage of it, while you can.
If you have questions about the surgery that I can answer to help you
make up your mind you can always come back in for another appointment
or email me. Something else which is sometimes helpful for patients is
to go to a support group meeting to talk to patients who have actually
had the surgery. You can find a schedule of support group meetings on
my website http://www.gsbwc.com/ under "events".
Vitamin D (let's get off the insurance topic for a while)
The official daily allowance for vitamin D from the Institute of
Medicine is 200 IU (international units) for people 50 and younger and
400 for those 51-70 and 600 for those over 71 or older. Many
researchers feel these recommendations are too low and feel most people
should probably get between 800-1000 IU. For patients who have had
weight loss surgery I would recommend an absolute minimum of 400 IU
particularly during the winter months. When you are shopping for a
supplement, read the fine print it should be D3 (also called
cholecalciferol). Few foods supply Vitamin D, milk is fortified and
fish such as salmon, tuna, and sardines are naturally rich in vitamin
D. The reason I am talking about this is because vitamin D deficiency
is by far the most common vitamin deficiency I see in my practice. Also
as I have mentioned in previous newsletters you need to get the level
measured which requires a blood test every 3-6 months.
Exercise
I'm sure you have heard the advice, from me and others to exercise
but what is the right amount of exercise? Much depends on the
individual patient, how fit you are to begin with, and how old you are.
This makes it difficult to make "one size fits all" advice. We can
start with the 2007 guidelines from the American College of Sports
Medicine and the American Heart Association; they suggest moderate
intensity exercise for 30 minutes five days a week or vigorous exercise
for 20 minutes three times per week. Moderate intensity exercise is
enough to break a sweat, raise your heart rate but still be able to
carry on a conversation. Brisk walking is the most practical, safest
form of moderate exercise. You can exercise in shorter bouts (but at
least 10 minutes). Three ten minute bouts is as good as a single 30
minute workout and may fit better into your schedule, for example
during a lunch break. Even if you can't meet the guidelines any amount of exercise of any
intensity is better than none and has heath benefits. What is the
payoff? Exercise lowers blood pressure, improves blood cholesterol
levels, improves mood and can even help alleviate depression. Regular
physical activity helps develop and maintain healthy bones, muscles,
and joints.
Seminar
I will be having my next patient information seminar at the Robert
Treat Hotel in Newark on Saturday February 23rd at 10 am. The address
of the hotel is 50 Park Place, Newark, NJ. If you know anyone who is
interested in finding out about the surgery I will be discussing both
the gastric bypass as well as the band. It is open to the public.
End Quote (The spirit of this quote is that having this surgery often involves a lot of ups and downs)
"The greatest glory in living lies not in never falling, but in rising every time we fall"
Nelson Mandela
Thanks for reading and trusting me with your healthcare
Michael Bilof, MD
drbilof@gwbwc.com
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