Revison to the DS

I had VSG in June 2012.  I lost 130 pounds in 15 months  I did well and had a regain of 10 pounds which I lost quickly.  I maintained fairly well with a few regains of 10-15 pounds which I was able to lose.  Until I didn't. In December 2015 I weighed 135 pounds.  The last time I weighed myself I was 162. That was about a month ago.  I have had good weeks and horrible ones.  I am considering a revision to DS.  

My question is do you think I qualify for it?  Will my insurance pay for a revision if I am not morbidly obese? My surgeon, who I have not seen in 2 years, does the SIPS procedure.  I think he was one of the doctors that first introduced it.  

I feel ashamed and judge myself hardly  I don't want to leave the house. I think this is hurting my relationship as I feel awful about myself.  I have been in therapy for 2 years this go around and we work on what is driving me back to food.  I am in full blown relapse and don't want to gain all the weight back.  I thought if I could take action I could avoid this.

I am 61 and am certainly concerned about having another surgery.  I also have some concerns regarding aftercare.  I have been good about getting my labs done and I take vitamins every day.  My endocrinologist follows me closely.  I also have no health issues with the exception of spinal stenosis and arthritis in my knees so again was not sure if my insurance would cover me. 

Sharing your experience and any information about insurance, I have Blue Cross/ Blue Shield, would be greatly appreciated. 

It depends on your insurance.  For revisions, my insurance requires I had a BMI that qualified at the time of the first WLS procedure (which I did).  I also have BCBS (IL, HMO).  I also must still be at least obese, I believe, and I forget what the BMI is.  I have no idea if they would agree to do it.  They might since there was 30 pounds of regain.  Unfortunately, you'd need to call your insurance and ask, or read the policy.  They are the ones who'd answer.

As for the SIPS, be aware that the SIPS is experimental, and at least in Illinois, BCBS does not cover it or any complications related to it.  In fact, my BCBS actually specifies the length ranges for each DS part (they get that particular) that the surgeons must do.  For example, the common channel is specified to be between 50-100cm (the SIPS/SADI is typically 200+).  It is not considered the same as the DS in terms of insurance.  My VSG surgeon pointed this out to me without me even asking, as he did not want me to get a surgery where I was stuck with complications, and chances for surgical complications are higher whenever there are gut anastomosis made.  This means if you did get something uncovered by insurance, you would have to pay out of pocket or might even be billed if an emergency occurs.

It sounds like you are going through a difficult time.  I am so sorry for that.  The good news is that you are seeking help.  If you are having issues leaving the house, a support group might also be good, as it will help with motivation and encouragement.  

many insurance companies will onlypay for revisions that are medically necessary,because something mechanical has happened to the original sleeve.

many won't accept weight loss alone,as they say that is " user error" not following protocol,etc. 

have you had a scope or any scans to see if your sleeve is functioning as it should?

I'm sorry you are going through such a tough time. I hope the therapy you are doing will help.

Regarding insurance, there are many different policies by each company, so you will need to get your EOC (evidence of coverage, NOT a little summary of benefits but a big 100 page or so document) and read the specifics of what, if anything, is covered in the way of revisions and what criteria you would need to meet to quality. Many policies do not cover revisions at all unless there is a proven anatomic defect of your original procedure. Weight gain alone is usually not enough to get people covered as the patient will be blamed for the regain. And some policies don't cover the DS at all, or only for people with a bmi over 50...you get the idea. So you need to learn the particulars of your policy. And don't trust some random employee to get it right for you, read the policy for yourself.

As someone else already said, SIPS is experimental and rarely covered by insurance whether for original procedure or revision. If you are already struggling with one operation, it doesn't make sense to me to go with something experimental in any event. I would want something tried and true with well documented excellent long term statistics, and that's the DS. The DS has the best statistics for percentage excess weight loss, for maintenance of that weight loss, and for resolution of almost all comorbidities, of any bariatric surgery. And your age isn't at all unreasonable. More and more people are having all sorts of surgery at your age, and far older. 61 is not that old!

Larra

Hello, 

Firstly, do NOT judge and be hard on yourself. Sometimes our bodies do whatever our bodies want to do. I had the DS about 4 years ago and it was a blessing to me. I absolutely LOVE the DS. However, that being said, different insurance companies have different policies. I had BCBS and I believe for a revision, they have similar qualifications as the initial qualifications. 

Do not lose hope. Keep your chin up and you need to know that you have done WONDERFULLY and should be proud of the success you have had thus far. Almost all of us experience some weight regain after surgery. I know that gaining 30 lbs makes your mind dwell on failure, and can give you flashbacks from when you were at your heaviest. However, you are not at your heaviest. You are still within 30 lbs of your lowest weight. You still have time to change some of your eating behaviors and stop the weight gain and even reverse it to be closer to the weight you prefer.

I would recommend trying not to blame yourself, keep a positive attitude and know that you CAN stop some of the weight gain. The weight loss surgery is a tool that can help you keep the weight off but it is far from infallible. Follow your doctors recommendations and stay as healthy as possible (both physically and mentally). When I gained some weight (too much for my taste), I went back to the diet that was closer to surgery. Try supplementing some protein shakes for meals, cut out some of the carbs, and focus on protein. Also, if possible, try walking to increase some of your physical activity. 

Good luck to you! I am sure that you are okay- sometimes our bodies change a bit and need to be shaken up. Keep your chin up and be proud of the success you have had from your original weight. 130 lb weight loss is absolutely incredible. You can do it!! :)

Thanks so much for the responses.  I just found out my insurance will be changing next year to United Healthcare.  Even with a PPO plan, the deductibles and coinsurance amounts are very high.  I really am giving this a lot of thought.  

I am certain that my weight gain has nothing and everything to do with food.  Yes I eat foods that my body does not need which causes the weight gain.  However, the addiction is really to the perceived  power that the food is giving me at that time.  Usually feelings of scarcity, fear and helplessness are the triggers. These are almost always not from the present moment.  I know another surgery will not help this.  This is my emotional work.

What I hate  more than anything is waking up each day now with the mantra I have to lose weight.  I am soooo tired of this.  For the time I was maintaining my weight this was the most amazing part. I hate that this takes up so much time and energy.  It sounds like the DS has a better maintenance outcome.  I am not sure why?  

Again thank you to all you have responded.  It is much appreciated.