DS rejected

I am so disappointed.  I called a DR in Kansas that does the DS, and found out BC/BS of Illinois will not cover a revision surgery!!  Even though I had to pay for the VSG myself.  I was told even if I wanted to self pay they wouldn't do the surgery because the risk for complications are higher.  I couldn't afford another surgery anyway, but that news really upsets me!  I feel really down!  Thanks for listening. 

 

I'm so sorry for your disappointing news. Have you talked to any other doctors? My mother had a VSG and then 6 months to a year later had the other half of the DS done. It's not unheard of that it's done in two parts. If this is a procedure you need and you're prepared for, then don't give up yet! Talk to other doctors!

so you have a vsg and want to add the intestinal bypass?  you are not a revision, unless you are revising your vsg, that is where the risk would be, resleeving. if you are not resleeving then the complications would not be greater, whoever gave you that information hopefully misunderstood you, or really doesn't have a clue.   i would call other drs and definitely look outside of the us to mexico or brazil (each country has a vetted surgeon) good luck to you

After 8 months of telling me they would do it, they dropped me like a hot potato when I had to change to self pay because insurance kept denying it. So I drove from Kansas to Dallas to have it done as a self pay. It was expensive but worth it so far. Had to withdrawal 401k but working on building that back up now.

Fight for what you want. If you can find a way to pay, I say go for it. Good luck with whatever you decide.

I don't know who you spoke with, but this is the first time I've ever heard of a DS surgeon being unwilling to do the switch part of the DS on someone who already had a VSG. Ever!

I understand you are upset and disappointed right now, but take the weekend to pull yourself together and be ready to call some other DS surgeons on Monday. You will have no problem finding someone willing to help you, the only issue will be cost.

And as far as your insurance goes, you might be able to appeal the "no revisions' thing if you have grounds for medical necessity, depending on your individual situation, your policy (which you need to read yourself and not trust any company employee to interpret for you) and what state you live in.

Don't give up yet, the journey has just begun.

Larra

To clarify, I had to have my sleeve redone and a hernia repaired. So I was a true revision. But as soon as I was denied by insurance, they explained that they had a "revision" patient pass away and no longer do them without insurance approval. I don't know if they meant a true revision or simply converting a good VSG to a DS. That would be a good thing to follow up on with them. And I'm referring to Dr. Berntsen's office in Topeka, the only one that does the DS in Kansas.

Try checking out TriStar Centennial Medical Center in Tenn.  Dr. Houston does the DS surgeries there.  And, unless something has changed, they guarantee their surgeries for 90 days.  As I understand it, if you have complications within the first 90 days after surgery, the treatment cost is on them.  I don't know that that includes the cost of a hospital stay but it could be helpful to you considering you want to go self-pay.  And, as for my own experience, I feel that Dr. Houston did an excellent job and I have been pleased with the level of continuing support that I've received from their office. 

 

Here's the link:  http://www.cmcwls.com/default

Hello,

I am going to a seminar in a couple of weeks with Dr. Houston. How log did it take you to get your insurance to approve the surgery.

How log did you stay in the hospital?

Any night in ICU?

pain control in the hospital and home.

Did you start on clear liquids in the hospital

I am hoping to get the DS.

Unfortunately I will need to have the procedure open due to surgeries on my stomach 

Oh my.. open surgery.  That's more complicated!  I stayed in the hospital 3 or 4 days but you might be longer.  The packet of information and monthly doctor visits required to be considered for wt loss approval took about 6 months with MY insurance.  Every insurance company has their own process.  Once I got that done and submitted, though, their decision was very fast.  I went ahead and did the ground work to know who I wanted to go with so that by the time I got approved for surgery, I was able to call the doctor's office to set up the surgery.

The pain management for me was excellent but I had laproscopic.  I started on liquids very quickly in the hospital (not clear but free flowing).  You have to be able to keep it down before going home.  Dr. Houston can sound a little flippant at times in his answers but bottom line is that I suspect he's a fantastic surgeon who knows his stuff and he does care about his patients.  The after care provided by their office is fantastic from what I've heard in comparison to some places but the nutritionists (and I'm assuming the doctors) try to nutritionally treat the DS like a variation of an RNY.  Their recommendations in terms of how many calories you're supposed to get in will have your body starving.  Keep your carbs low, protein above 100 grams and your fat on the high side (but do things slowly to give your body time to adjust to what you're asking of it).  Don't push milk products too early.  Some people become lactose intolerant.  Give your body time to adjust.

Good luck!!!

If cost is the issue, check out Mexico.  The surgery (virgin DS) was under 20K, and that included hospital stay.  That was the number I got late last year.