Dr. Greenbaum for revision?
(deactivated member)
on 7/14/09 12:52 am
on 7/14/09 12:52 am
I need a revision. Bad. My RNY stoma is 4 cm, bigger than any US coin. You guys told me that Greenbaum is the most experienced revision person. So, Ive been to him, but now my insurance says that they don't cover revisions. I need my pyloric valve back. I have uncontrollable bowel movements because the stoma is too big.
Has anyone had experience good/bad with Greenbaum?
Has anyone been self-pay with Greenbaum? How much did things cost?
You can send me a personal message if you would feel more comfortable.
Has anyone had experience good/bad with Greenbaum?
Has anyone been self-pay with Greenbaum? How much did things cost?
You can send me a personal message if you would feel more comfortable.
(deactivated member)
on 7/14/09 1:46 am, edited 7/14/09 6:28 am
on 7/14/09 1:46 am, edited 7/14/09 6:28 am
I have Inter-County which is administered by Amerihealth. Amerihealth does all their appproval stuff for them.
Yes, they say that they cover things if "medically necessary." But they write that second surgical proceedures are not covered unless there are "complications."
They exclude "weight gain or weight plateau from the dilation and other stabilization of the gastric pouch as a natural and ordinary occurence in teh aftermath of the first bariatric surgery."
I don't think that a 4 cm STOMA s natural or ordinary. Nor is crapping one's pants.
I'm having trouble finding medical journal information which might detail what "natural and ordinary" would be. Yes, I was told that the pouch would stretch, but not that the stoma would become bizarrely enlarged. Where can I find data about "normal" changes after RNY?
Yes, they say that they cover things if "medically necessary." But they write that second surgical proceedures are not covered unless there are "complications."
They exclude "weight gain or weight plateau from the dilation and other stabilization of the gastric pouch as a natural and ordinary occurence in teh aftermath of the first bariatric surgery."
I don't think that a 4 cm STOMA s natural or ordinary. Nor is crapping one's pants.
I'm having trouble finding medical journal information which might detail what "natural and ordinary" would be. Yes, I was told that the pouch would stretch, but not that the stoma would become bizarrely enlarged. Where can I find data about "normal" changes after RNY?
In my HUMBLE opinion, and from what I have seen get approved in the past, the frequent diarrhea is the "complication" that would facilitate an approval, not necessarily the enlarged pouch, which is usually deemed a "natural occurence."
Hvae you had any studies done that can be used to substantiate your claim to the insurance company? Amerihealth is difficult anyway. I just wonder if there might be anything else mechanically going on that you could use to get an approval.
Hvae you had any studies done that can be used to substantiate your claim to the insurance company? Amerihealth is difficult anyway. I just wonder if there might be anything else mechanically going on that you could use to get an approval.
(deactivated member)
on 7/14/09 3:06 am
on 7/14/09 3:06 am
Well, here's what I typed up as complications.
• Frequent diarrhea
• Fecal incontinence, “which is defined as the loss of anal sphincter control or the inability to defer the call to defecate to a socially acceptable time and place, resulting in the release of gas, liquid, or solid stool." [Rockwood TH, Church JM, Fleshman JW, et al. Fecal Incontinence Quality of Life Scale: quality of life instrument for patients with fecal incontinence. Dis Colon Rectum. 2000;43(1):9–16. This scale has been shown to be produce reliable and valid measurements in Oliveira L, Wexner SD. Anal incontinence. In Wexner SD, Beck DE (eds). Fundamentals of Anorectal Surgery, 2nd ed. London, UK: WB Saunders; 1998.]
• 6-8 bowel movements a day, a number clearly out of line with a normal population
• Nutritional Deficiencies, despite taking the required supplements (D)
• Excessive Vomiting, especially at the beginning. I believe that this vomiting disrupted the proper healing of the stoma in the first place, as it was demonstrated that the stoma was not right just twelve months after surgery.
• Borderline Diabetes (fasting result 100, where the upper limit on the test was 99)
• Hiatal Hernia
• Frequent diarrhea
• Fecal incontinence, “which is defined as the loss of anal sphincter control or the inability to defer the call to defecate to a socially acceptable time and place, resulting in the release of gas, liquid, or solid stool." [Rockwood TH, Church JM, Fleshman JW, et al. Fecal Incontinence Quality of Life Scale: quality of life instrument for patients with fecal incontinence. Dis Colon Rectum. 2000;43(1):9–16. This scale has been shown to be produce reliable and valid measurements in Oliveira L, Wexner SD. Anal incontinence. In Wexner SD, Beck DE (eds). Fundamentals of Anorectal Surgery, 2nd ed. London, UK: WB Saunders; 1998.]
• 6-8 bowel movements a day, a number clearly out of line with a normal population
• Nutritional Deficiencies, despite taking the required supplements (D)
• Excessive Vomiting, especially at the beginning. I believe that this vomiting disrupted the proper healing of the stoma in the first place, as it was demonstrated that the stoma was not right just twelve months after surgery.
• Borderline Diabetes (fasting result 100, where the upper limit on the test was 99)
• Hiatal Hernia
I am impressed, you have absolutely done your homework! Unfortunately, my experience with AmeriHealth has not been a positive one in getting these cases approved. However, if you have already been denied once, you can go thru a 1st level appeal, or whatever surgeon you choose can do a peer-to-peer review. In the general RNY patient population, frequent diarrhea is not an issue for one as far out from surgery as you are. DO NOT GIVE UP! I had one patient appeal her insurance decision for over a year, and she finally got approved!
(deactivated member)
on 7/14/09 10:30 am
on 7/14/09 10:30 am
Yes, I have done some research.
Peer-to-peer review, in my case, seems to have just been a delay tactic.
It seems that I'm not the only one with the RNY bathroom problems. They warned all the DSers in my support group about bathroom issues, but nobody said much about RNYers with those problems.
I have many of the disadvantages of the DS, but not the advantages.
I vomited like crazy the first few months. I couldn't even get the vitamins down or one well-chewed piece of shrimp. Then the vomiting went away.
Peer-to-peer review, in my case, seems to have just been a delay tactic.
It seems that I'm not the only one with the RNY bathroom problems. They warned all the DSers in my support group about bathroom issues, but nobody said much about RNYers with those problems.
I have many of the disadvantages of the DS, but not the advantages.
I vomited like crazy the first few months. I couldn't even get the vitamins down or one well-chewed piece of shrimp. Then the vomiting went away.
Most Active
Recent Topics
