Need advice...botched sleeve.

Ok, so it's been awhile since I've been here because I don't fit in.  For those of you that I've never met, I had a sleeve done on 4-6-11.  I lost 10lbs pre-op and have lost 8lbs since surgery.  Completely wasted surgery.  Anyways, I have been looking into DS because the sleeve is doing nothing for me, obviously.  I submitted for insurance and was denied because they say that now that I lost the 18lbs my BMI is too low to qualify for DS.  My new surgeon wanted to do an endoscopy to find out what is going on and why I'm not losing.  This was done yesterday and here is what it found.  My sleeve is VERY large.  If the endoscopy doc couldn't have seent he staples, he would've never known I had surgery at all.  My stomach measures 44mm and aparently a 32f bougie is 11mm, which is supposedly what was used.  The fundus (which is SUPPOSEDLY removed with a sleeve, getting rid of stretching and the grehlin) is "completely intact and has no areas of narrowing". GRRRR
I'm so pissed off I could kill someone.  So now, my new surgeon is resubmitting everything, including the endoscopy to insurance again to appeal.  I have a question for you all....would you sue?  I am so angry that I went through all this, all the recovery, not holding my babies, frusteration of not losing anything, and now finding out that I did that all for NOTHING because my surgeon is a ******g idiot.  Now, to top it all off, the 18lbs total that I lost put my BMI just under what it needs to be in order to get DS.  I do NOT want rny, and Dr. Buchwald highly recommends a DS for me.  He sees no reason in waiting because he says I will just gain more weight than I already have since surgery.  What do you guys think?  Thank you in advance for your thoughts.

I would talk to my current surgeon and ask if what he saw was typical.  Then I would request my surgical records.  I would take both to an attorney and see. 

You said you do not want the RNY, so are they saying you qualify for it? If your insurance has different BMI requirements for the RNY and DS, you can fight that. Sleeve, DS or RNY all have the requirement of 40 bmi, or 35 with co morbs.

All of the other bariatric surgeries have a 45 BMI rewuirement....except the DS...which is 50

Not acceptable and easily appealed.  The insurance person at Dr. B's office shoud be able to help you with this.

She is on it.  Are they not allowed to set different requirements for DS than others or something?

They are "allowed," but it is usually only upheld if there is sufficient documentation to support such a requirement. Since the ASMBS and Medicare and multiple studies require only a BMI of 40 for ANY form of WLS (or 35 + comorbs), you should be able to successfully appeal.

Thank you very much for your information, I will pass it onto Buchwald's nurse, if she isn't already aware.

I am not a litigious person by nature, and in this case, hell yes, I would sue.    Your post exemplifies why ANYone having ANY bariatric surgery needs to do their research and find out how many of said procedures their surgeon has done.

 I think Dr. Buchwald is a great surgeon, with a great reputation.  So, this time, you are on the right  course.  Could you share with us your former surgeon's name, so others know to avoid him.  Also, I would see an attorney to see if you have a case.  

The DS is the way to go!  I love my DS!