VBG Repair Needed & I'm DISCOURAGED!

Hello. This is my first time posting on this board (I just found it this afternoon). I am 39 and just about 12 years post op VBG. We found out a couple months ago that I have two staple line disruptions, a hole in the top of my stoma allowing all my intake (which has been down to basically soft foods for the past few years) into the left side of my abdomen which is my lumen, the old stomach that was stapled off and that the prosthetic band has corroded into my stoma pouch. After contacting the Bariatric surgeon here in Rome my GI DR has sent me to Emory. The local surgeon doesn't do repairs/revisions. My goodness!! Has ANYONE dealt with these people at Emory?! I think I may end up in a different hospital at this rate, LOL. Along with figuring out why my health has gone so down hill and I have gained back about 80 of the 220 pounds of the weight I had originally lost we have found out that my husband's employer has decided to eliminate the bariatric coverage of our insurance come June 3oth with the company's reenrolment this year! I have seen so many doctor's and specialists the last nine days I don't know if I am coming or going. I have to get a list of pre cert requirements done before Emory will even contact my insurance company to see if we can do a repair! I have my GI DR and the original surgeon who is now in Texas telling me I have NO OPTION other than a gastric bypass due to the extent of the damage or I can expect the damage to make me a fatality! Sure, scare the crap out of me! Emory telling me I have to go thorough the pre op things regardless of the fact that this is not my fault but a defect in my prior procedure. I have done EVERYTHING but STILL need to meet with a nutritionist BEFORE they will send anything for pre cert consideration and the dietitian can't see me until the 21st!!!!! I am now running a steady fever of about 100 - 101 and unable to drive to ATLA for the Nutritional consult so that's why I am waiting for my set appt. June 21st here. I have even done all the things that are required as step 2 so that God willing we get an approval and I have them all done before the June 30TH deadline. I REALLY NEED some support with all this. My family and friends have been great but still having someone who knows the basic feelings of what we are going through with WLS would be FANTASTIC. Never in a MILLION years would I have told you even six months ago I would be having this done but sometimes things just happen. Actually with PRAYING I get the nutritionist consult in and my approval before the end of the month I am now thinking of well at 233 I do need to loose about 80 pounds to be back to a healthy weight but wont I loose much more with a gastric bypass? Then what! Anyone interested in giving me advice and support I promise I will return to you a true forever friend who cold never tell you how much I appreciate it!

Lisa, Dont be discouraged. I believe the problems many people are having with the band is the reason why many insurances are not covering the banding process anymore. I know it is rough going through the hoops..but it is either this or going to meet God face to face as the doctors have told you. My best support was prayer. I prayed that if it was God's will for me to have this surgery, then He would let all the pieces fall into place. And he did. The question I would have for you is, if this is a complication, and they covered it to begin with, would the insurance not cover this now because it could be a life threatening situation if you dont have a repair done???? I would call them back and discuss this with them. Good luck and if you ever want to talk to just let off steam, feel free to email or write. D'Lynn RNY 3/22/05 232/188

D' Lynn, What a cool name! I actually spoke to my husband's company's rep that deals directly with BCBS and she said that all Emory has to do is at least send in something to let them know we are needing this surgery BUT NO ... they have to have the Endocrine with TSH (that was done in April & is current), have to see the psychologist for a pre op consult & PAI (done yesterday and I have the report this morning, he mentions I scored high for anxiety, dah, wonder why, LOL, my response when he said that was a cute little 'Ya think', hehehe), I have to do a diary of weight loss attempts which I have had up to date for about three years so that is way beyond done, and the final thing BEFORE Emory will fax it to BC is this nutritionist visit. UNREAL! I also called BC myself last week (or maybe week before) and the lady was real nice but regardless of the fact that this surgery is to save my life makes NO difference to them, it is STILL bariatric surgery and as of the end of the month I am out of luck if we don't get approved!!! I am in the state of SHOCK about it!

That is so very wrong!!! I cannot understand why they consider it a life saving procedure if you will die if you dont have the surgery. At least you have a few days to go to finish to hopefully get it approved. Is there alternatives to bypass surgery if you dont get approved. I mean if it is a life threatening thing, they have to do something to at least repair it? If you are denied, I would get a lawyer to see if you can get it some help. I am here for you. This is very upsetting. D'Lynn

Lisa, I am sitting here in shock that they would make you go through a preop approval to have an emergency procedure done. I agree with D'Lynn. I would definately be calling a lawyer. Food emptying into your abdominal cavity is LIFE THREATENING. Have you called you PCP to tell him whats going on with emory? At the very least you need to be on an antibiotic therapy. The fever is telling us something. Insurance bureaucracy is a huge pet peeve of mine, paper pushers acting as God to determine our health care!!! I wish I had an answer or even a suggestion for you. Keep all your faith in God. Please keep in touch with your PCP, even calling everyday if you have to. Let him get in touch with emory. Also, I'm just re-iterating what D'Lynn said, how can insurance company deny surgery to treat a life threatening condition, no matter if it has to do with a previous surgery? Keep being proactive Lisa. I will keep you in my thoughts and prayers. Barb

Oh yes, my PCP and my GI doctor as well are both not only speaking to me daily on the phone but also I speak at least a couple times each day with both of their assistants. We are all too the point all I have to do is say 'hi' and the recognize my voice. We are all busting our humps to get me in the OR ASAP. I have been debating about getting an attorney to get through this crap but am just so preoccupied jumping through the hoops that I really haven't had time to do anything more then briefly think of it. Actually, my GI doc has spoke to the surgeon at Emory about three times a week, this is the second week, averaging about an hour each conversation, trying to get them to help do something. Deaf ears I guess since I am still siting here getting more scared everyday. I do have a couple more questions for the board though. I went to my 'to be' surgeons profile/formum on here and the picture they have posted is no where even close to being the same person pictured on Emory's Bariatric page. I even printed both out to do a detailed comparison and they are NOT the same photograph. Not even if you age one or the other. Which leads me to several questions. Let me say this before I start with them though. I went through and read prior patient posts about my surgeon and a lot have nothing good to say about the staff but that the surgeon is good. See, I don't know about which photo is accurate or even his bedside manner because when I went to the clinic on Tuesday last week, after he PERSONALLY told my GI doc here in Rome (I am just outside of Rome) that he (the DR at Emory) was going to take care of me personally NEVER came into the exam room to meet me. And I even had to sit and wait for my 11:45 appointment that ended up my being seen at 2PM! So I have no clue WHAT he looks like or his demeanor. I met with one of his staff surgeons, we know she said she is a surgeon, we think she is a resident but not even sure of that. I stopped reading the posts that I printed out because now it has got to the point I told the husband (after fussing all afternoon with each other) 'forget it I am NOT gonna go through this another day!' So of course now he and I are just not talking. I just don't know WHAT I am supposed to do!!!! Hopefully I'll get to meet this surgeon BEFORE he operates on me, if I can even get it through! But back to the original, yes, PCP & GI have been fantastic about helping me but they seem to think the fever and high white count (13,000) is due to the band basically being a 'foreign object' in my stoma. Added I think they are thinking in their hearts and minds we will be on the table before it gets any more serious. To be honest, maybe I'm being too big a baby, but I feel like crap, physically, and now emotionally, I doubt it could get any more 'serious'.

Hi Lisa, I sent you a private email but I think I have discovered a common mistake that is made about your choice of surgeon. Dr C. Daniel Smith is affiliated with the Emory program Dr. Daniel C. Smith is affiliated with his own practice (cannot remember the name) and is out of Marietta,GA I hope this help clears up some of the confusion. Marie

Hi Lisa.... Try not to be discouraged... I don't see any problem with the insurance paying for this as it is repair work, not an initial surgery. And because what you are going thru is life threatening, it should be covered regardless of when your insurance will be no longer covering wls. It sounds as having the RNY is your only option for repair of the previously failed surgery. It isn't like you are considering this new. However, the folks at Emory probably have their protocols, and tey have to follow them. And I would think (I know... thats a dangerous thing for me to do... lol) that because you will be going thru the process all over again, they want to make sure everything is working and you know what to expect with this new surgery vs the old VBG. I guess times really have changed, and the way we handle this surgery could be different than when you had your VBG. Good Luck to you as you go thru this... We will all keep you in our prayers... Susan Lap RNY 12-1-04 285-195-155 (-90)

Lisa, I am so sorry and concernedabout your situation. Don't take no for an answer, be relentless in your pursuit. You have gotten some very good advice hereand I agree with them all. Since time is of the essence you don't have a moment to waste. Maybe try going to the main board and posting, the flow of people there is so great you may be able to get help from someone who works in insurance, as lawyer, for lawyer, or can put you in touch with someone, etc. The board moves so fast, post in the am and again in the pm so that more and a variety of people will see it. It's worth a try, exhaust all options. I hope everything works out very soon sweetie, you are in my prayers. Keep us posted, we care. Meso