Read part one…
I decided in December that I would start a program, regardless of cost, after the New Year. As I’ve mentioned, New Year’s Eve is a big holiday in my family. I hosted dinner that evening, that saw a lot of pasta, meat (I made this pancetta-wrapped pork roast that never fails to taste good…think about it, pork wrapped in pork…right?) and seafood eaten. There was also a lot of beer consumed, namely by me. I drank a case of Blue Moon‘s winter seasonal that night. Do the math…24 bottles multiplied by 12 ounces is 288 ounces, or about two gallons of beer. Worse, at 200 calories a pop, I laid waste to nearly 5,000 calories in beer.
In one night.
I know. The Wife has already said it. A few times.
On the first weekday of 2010, I made an appointment with my NP (I have a doctor, but he is less than fulfilling as a practitioner. And as a person. But, if not for him, I would never have seen the NP, who has been much more receptive to my issues and needs over time.) and told her what I wanted to do. She was floored (in a good way) and together, we wrote a letter of medical necessity to get my insurance company to cover some of this.
Dr. Wendy Scinta operates her practice, Medical Weight Loss of New York, in Manlius. Unfortunately, she is a Duke University graduate, but she is the only doctor board-certified in bariatrics in the region. I guess everything balances itself out in the end. I came across her website and practice after reading an article in The Post-Standard where she was quoted. It seemed like everything I was looking for from a program, though I had some concerns about how I would adjust to the intensity of the program.
My first meeting with the practice was actually a consultation with the office manager. Jen, who I later learned was both a client and employee, gave me the pitch on the program and explained how everything works. I walked out, certain that I was going to go broke doing this, with an appointment for January 9. But, it was either go broke or drop dead, and this is exactly why they make credit cards, right?
That Saturday morning, I met with the office’s nurse practitioner who gave me a bariatric physical. Essentially, I got an overall workup as well as an EKG, blood work and a body GEM measure. The GEM looks like a cup with a straw lying horizontally on top of it. Breathing into it measured my resting metabolic rate, or the amount of calories it took to sustain my fat ass just sitting around all day. Three hours later, I handed over $511 and went on my way.
Yeah, $511. See, insurance companies have a process calling parring where they determine what they will pay a doctor for a service. They can take it or leave it. For instance, your doctor may charge $150 for an office sick visit. Your insurance company may say to the doctor, “That’s nice. We only pay $110 for an office visit.” Your doctor has two choices: 1) Take the $110 and eat the extra $40 or 2) Tell the insurance company to shove their $110. This, of course, limits your customer base, so most doctors take the $110. The insurance companies are a lot like OPEC. Digressing…
Dr. Scinta goes with number two. Part of this comes with the fact that so much of her treatment — GEM monitoring, meal replacements — is not covered by major insurance companies. Plus, if you offer a service that no one else does, why would you par your fee? It sucks as a patient, mostly because even though they warn you, the number is still shocking. And, payment is expected at the time of service, as I would learn the hard way:
RECEPTIONIST: “So, that’s going to be $511 today.”
JARED: “Sure, what’s the mailing address.
RECEPTIONIST: “Oh. Uh. Payment is due right now. We close our books at the end of every day.”
JARED: “Oh. Okay. Well, can I give you a call back once I talk to my wife about which card this is going to go on?”
RECEPTIONIST, turning phone in my direction: “You can just give her a call right now.”
Apparently, I’m one of the lucky ones. My insurance company approved the treatment, after a little bit of arm wrestling, and I had to submit claims one-by-one. The result was about 50 percent reimbursement, which is significantly higher than other insurers. Apparently one insurer was paying less than 20 percent. Eek. The first $511 covered my deductible for the year (Surprise to the guy who went to the doctor’s in January!), so the subsequent $100 or $150 visits were reimbursed at about $50-75.
The scale used by Dr. Scinta, and most weight loss doctors I would imagine, measures your weight in proportion to your height, as well as how many pounds of muscle, fat and water you are carrying around. My first weigh-in put me at a robust 333 pounds. This is by far the heaviest I have ever been. Quite scary actually. During my follow up appointment, the doctor was pretty clear that my weight caused:
- Much of the lower back pain I was experiencing
- The overall lack of energy I was feeling
- Restricted air flow while sleeping (not quite apnea) which was preventing me from rebuilding my energy
My resting BP and pulse also gave her cause to worry. Remember, my initial appointment on January 9 was 7:30 a.m. No real stress of the day. No food or drink ingested. I drove 30 minutes across town with no incident. My BP was 132/84 and my pulse was 91. All I was doing was sitting in a chair.
The bloodwork was even worse:
- Even though I was on Lipitor, my cholesterol was 253.
- My glucose and sugars showed that I was well into type two diabetes. My fasting blood sugar was a 120. It gets worse. My A1C blood glucose level was a 7.3 (high end of the normal range is 6.5) and my estimated average glucose was 163.
- I was insulin resistant. Not just a little insulin resistant either. Normal blood insulin is 6-27 mU/L. I was a 71.7. The doctor actually circled the number and wrote, “Wow.”
- My ALT level, which measures liver functions, was a 96 (the high end of normal is 69).
- I had a Vitamin D deficiency, which likely promoted the diabetes onset, as well as helped the fat deposits to store. The normal range is 30-75. Mine was 6.
I was alive, but on this current course things weren’t looking good.
The doctor assured me that things would change as long as I was willing to work at it. She went through the program and sent me on my way from the second appointment, this time with the food. Or what passed for food.