Revision needed at only 4 mths. out?

Hey guys it is official I need a revision or an Endoscopic Gastric Bypass Repair as a doctor in Boston calls it........I discovered this officially on 4/4/04 and was questioning what was up about 8 weeks after my original surgery. The problem is a huge stoma outlet. Dr. Duncan is currently reviewing two doctors to choose from to perform the repair. My big question is does BCBS/HMO Blue Choice cover this??? Here I go again!! Anyone know or know anyone that might know other than the insurance company themselves (I don't trust them too much)? Appreciating all and any help, Debbie in need of revision

Hi Debbie! First thing I would do is call your insurance membership official. Since you have already had the surgery and you should already be approved for followup care under your approved referral. Call them first! If the revision is necessary to complete because of your health I would think they have no choice but to pay. I would call them immediately. Stand up to your insurance company, remember you pay them for services and they are responsible for assisting you! Don't be intimidated by them, its your company and you who pay the premiums. Try to be positive and know it will all fall into place. In my thoughts and prayers for a speedy recover. ki

Debbie, what happened to cause you to have a "huge stoma outlet?" At only 4 months out? Wow! My uneducated guess is, your insurance company may not be very willing to pay for what they may consider a "second" gastric by-pass. Maybe you could call your insurance company.......not give them your name and ask them a "what if" type of question and see what they have to say...........you could be surprised and it could be covered. Good Luck Debbie J Duncan patient 01-14-02 lap-rny 01-15-02 leak repair surgery (non smoker, non steroid taker) 01-29-02 surgery to see if I had another leak.........NO, thank goodness SEVERE COMPLICATIONS!! 45 days in ICU, 33 days kept alive via ventilator 30 days in a rehab hospital, had to learn to walk again Now, one happy girl...........LUCKY to be alive

According to two surgeons anybody's guess is what caused the stoma outlet to be so large. Since several things could of caused it we will never know what the cause was exactly. I do know that I started wondering about the issue at only 8 weeks out from my original surgery so it happened before I was 4 mths. out. I personally think it was never made small enough with the original surgery but that is just a guess based on how easy everything went after surgery. I am having a "repair" to my gastric bypass not another gastric bypass therfore the insurance company should cover it from everything I've been able to find out so far. It is a minor procedure. They go in thru the scope and suture the opening smaller. I'll be able to go to work the following day. Thanks for your interest and suggestions. Debbie

Debbie, Ray and I have been wondering how you were doing. Sure hope your insurance will cover the revision/repair. It seems if it is presented as a repair it would be covered. Hope to see you Wednesday night at the Carrollton support group meeting. Hugs, Debbie M

Thanks Debbie! I'm planning on being there Wednesday unless something comes up. I am looking forward to seeing y'all. I hope Ray is doing well and you too! See ya later - Debbie

Ray is doing great. He's down 64 lbs. Gone from a tight size 60 pants to a loose size 54. I'm fine now. Had a little fright with my yearly checkup this past month but it all turned out to be nothing. I think they were just trying to see if there was anything left of my sanity. LOL Nope that left a long time ago. I'm completely nutts. See ya Wednesday. Debbie M