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Gastric Packet

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					                   Surgical Group Gainesville             of                              P.A.


         1143 NW 64th terrace Gainesville Florida 32605 (352) 331-1201 EXT 1025      Fax (352) 331-5273




Dear Gastric Bypass/Lapband Patients,

Surgical Group of Gainesville’s physicians and assistants, (Peter Sarantos MD, Timothy Hipp MD,
Jeff Rose MD, Bruce Brient MD, Cindy Anders PAC, and Linda McMahon CST\CFA) welcome you
and wish to provide you with important information regarding your decision to have bariatric
surgery. This letter will answer frequently asked questions regarding your gastric bypass/lapband
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 eight general surgeons. Five of these surgeons (Dr.
Timothy Hipp, Dr. Peter Sarantos, Dr. Jeff Rose, 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 twelve 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 twelve 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.

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
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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 twelve
       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.

    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: Copies of your medical records from the previous six
       months, which must include documented weight from five years ago and your physician’s
       notes describing weight loss programs you have attempted over the five years. This
       information is usually obtained through copies of your medical records from your primary
       care physician from up to five years ago.

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

    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
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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 made prior to scheduling your surgery date.
This includes, but is not limited to all co-pays and co-insurance amounts for pre-determined
post-op physician appointments that will be scheduled after your surgery is completed.

All Medicare recipients are required to make a prepayment for all applicable deductibles
and co-payments to Surgical Group of Gainesville. If for any reason Medicare or 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?

Bariatric 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, whose job allowed, return
as early as one to 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
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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.

What Is An Arbitration Agreement?

You deserve the very best medical care. Our surgeons are dedicated to providing just that.
Unfortunately, a serious healthcare crisis is facing our community that threatens our ability to
provide you with the care you need. Because Florida law doesn’t do enough to stop frivolous
lawsuits, doctors’ malpractice insurance rates are skyrocketing out of control, forcing physicians to
stop doing high-risk procedures. Bariatric surgery is considered one of those high-risk procedures.

In order for our surgeons to continue doing this procedure, Surgical Group of Gainesville will ask
you to sign an arbitration agreement. A copy of this agreement is included with this letter. The
arbitration agreement simply states that (By signing the agreement you are waiving your rights
to a jury trial and you are agreeing to arbitrate all claims arising out of or related to your
medical care and treatment from Surgical Group of Gainesville PA’s doctors and/or staff.)

During your first visit we will be showing you a short six-minute video explaining this agreement in
greater detail. At the end of the video we will try and answer any questions you may have about the
arbitration agreement. You will be asked at that time to then sign the agreement. If you elect not to
sign the arbitration agreement for whatever reason, your visit and future care regarding gastric bypass
surgery will be concluded at that time.

We are pleased you have selected Surgical Group of Gainesville for your surgical needs and look
forward to assisting you with this process.

Sincerely,




Patrick J. Bizub
Practice Manager

				
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