Denied for revision GHI Help!!!

I have been crying all morning.GHI will not do a revision because Im just a failure not a technical failure in thier eyes.I have this stupid band sine 06 that never worked no matter  how many times I got it filled.Everything just gets stuck so I have no choice but to eat crap.A peer review is scheduled tommorow don't know if it will help Im praying.I have high blood pressure,diabetes,sleep apnea,arthritus and worst of all psuedotumor.This isnt enough for them.My BMI is over 60,I can barely walk anymore,barely breathe and live with a headache from the psuedotumor everyday because the fluid is constantly building up in my brain.The spinal tap needed to drain the fluid is so painful because of my size that sometimes its better to live with the headache.What is wrong with these insurance companies?Do I need to have the band removed then go for the RNY?Wouldnt it be easier to put me thru 1 surgery instead of two?What am I suppose to do?I have a 12 year old son that needs me.I have never been so desperate in my life.I know I rambling but I am petrified of not being here for my son.Please any help on what I can do would be appreciated.I had to go to NYS insurance to get the band covered so I don't know if they would over-turn this again.

I'm so sorry you're dealing with this insurance nightmare!  I had an insurance nightmare, myself, when I needed a revision.  It's a terrible thing to have to deal with, and I'm glad you're not giving up.  The thing to remember here, is you cannot beat yourself up.  They'll never know exactly what's going on with your band, unless they open you up.  Nobody could find out what what wrong with my band, until I had my revision.  I had all of the signs and symptoms of a slipped band, and some signs of erosion.  Low and behold, I actually had BOTH!!!  The stitch that holds the band in place had come undone, causing the band to tilt on my stomach.  Anyway......

You have to do what's best for YOU and YOUR SON.  You know that he needs you to be healthy, so your job is to make that happen, whether insurance pays or not.  Have you considered the DS?  The DS was the best option for me, because it allows me to have a fully functioning stomach, not just a surgeon made pouch.  DS patients don't have dumping syndrome, like many RNY folks do, due to having a normally functioning stomach.  The DS has a 98% resolution rate for type II diabetes, and also cures sleep apnea, and resolves high blood pressure and high cholesterol issues. 

I eat like a "normal" person now.  I always eat protein first, and usually end up filling up my stomach with all of that protein.  I rarely even crave breads or pastas since surgery.  If I do choose to eat bread or sugary treats, the worst thing that happens to me is a little bit of gas.  All of those horror stories people tell about constant diahrea (sp?) and nasty gas?  It's bullcrappy.

My insurance company denied my revision, because they feel the DS is "investigational".  Even after I proved to them that this surgery has been being performed since the 1970's, they refused to pay for my surgery.  I got a personal loan from my bank to pay for my revision.  With travel and lodging, my surgery cost me about $25,000.  My payment per month is about $400.  Are you worth $400 a month?  For me, I spent about that much per month on cigarettes, fast food, and junk food before my DS.  I am worth WAY more than $400 a month.  The most important things are that my sons got their mom back, and my husband got his wife back.  Before my DS, I hated myself and my life.  I got my life back when I got my DS.  I went from barely being able to climb a flight of stairs, to training for my first 5K.....in just six months! 

This is getting kind of long, but I'd be more than happy to help you in any way that I can.  Please feel free to PM me and I'll give you more information if you'd like.  In the meantime, though, check out www.dsfacts.com .  It's the most complete set of information regarding the DS procedure, including locating surgeons, out there!  Also, come on over to the DS forum and read, read, read.  Feel free to ask any questions you might have there, too!  Lots of us are band to DS revisions over there and can help you out.

Wendy

Thanks so much for your kind words.I did ask about the DS.He said it was definetly an option for me.Im just so sick of having to fight for everything.We have insurance and they just allways get away without paying and it's just not fair.Peopl that arent severely obese just dont understand how hard it is to live as a heavy person.I hope I can get it overturned,I just am tired of the fight!Thanks again and congratulations to you on your surgery and weightloss.

I don't recognize your surgeon's name, as far as one who is experienced with the DS procedure.  There aren't many who perform the DS.  DSfacts.com will show you DS surgeon's closest to you.  If you end up having to self pay and want the DS, Dr. Stewart in Texas has the most reasonable self pay rates in the U.S. 

Don't give up!  Keep fighting until you get what you need for you.....even if it means you have to pay yourself, do it!

 You're in a tough spot. My mother had the band put in a few years ago, and for various reasons it hasn't worked for her. Her BMI is over 80, so her situation is pretty critical, too. She did finally find a doctor who will take out the band and do the bypass. 

Personally, in your situation, I'd probably go ahead with the bypass, for the following reasons: 
1) you've obviously pursued many fills on this band that haven't worked...there's no guarantee a revision would work, and you could end up right back here (and have wasted time, too);
2) your son needs you now, especially as he goes into his teen years (I have a 13-yr-old boy too, so I understand exactly how you feel), and
3) I see the difference between surgeries as a quality-of-life choice...if your quality of life is dramatically affected by your weight, then you need a more aggressive tool. 

Again, this is my personal take on the situation, ultimately you have to make a choice that you're happy with. Prayers and hugs! 

~Jen

I am so sorry to hear this.  Sounds like "Truckdrivinmama" gave you some very good advice, but if you won't have the means to get a loan like that, just keep fighting the insurance company.  I know I have already had to have surgery to fix my slipped band, and if something else happened I would be begging and pleading for a revision from the insurance company!

many people get approved after the peer review.  Write down all the reasons you want and need the revision.  Make sure you let them know about all the problems you still have.

Good luck!!


Tamara

Thanks for your words of encouragement.Im really hoping the peer reveiw will help.I will know tommorrow

Oh sweetheart, I remember posting with you when I first got my band in April of 07.  I'm so sorry you're having such a crappy time.

And I know you're tired of fighting for everything but it's worth it!  You are worth it!!

With a BMI over 60, please please please look into the DS. 


HUUUUUGE HUGS!!!!

Hi Janinie,
If you dont mind me asking did you have a problem getting a revision?The band has just not helped me and no one understands why?I just have never had restiction.I'm so happy for you that you are doing well.My doc does do the DS but I can't even get them to approve a revision.He did say a DS was an option for me,but decided on Rny I'm not sure exactly why he decided that would be better for me as he never said.I had originally asked about the DS.The problem for me is the insurance does not want to pay for it because they say I have a functional band.I'm hoping with the peer review tommorow there will be a change.Please keep our fingers crossed.I will post as soon as I hear anything.Keep up the good work and thanks for the encouragement