Sad Failure :( How do you fight the insurance?

imgonnabehot .
on 6/20/12 11:47 am - FL
Hi,  I am a little over 7yrs out from my surgery.  Initially, I lost like crazy and the weight came off so easily.  I felt great!  I went from 342lbs to 200lbs in just about a year.  Everything was great until February, 2009 (right before my 2yr mark).  All the suddent something changed and I started to gain weight.  This was new to me after losing so much and I shrugged it off as normal.  5lbs became 10lbs and I kept telling myself I could get it off like I did before.  Fast forward to now and I have gained back 55lbs.  The crazy thing is that I really didn't change anything regarding my eating habits, other than being able to eat more.  In addition, about a year ago I noticed that I would get these horrible sharp pains in various places in my stomach when I tightened my stomach muscles. Developed severe anemia (had to get three iron infusions)  My HBP is back and I feel like a miserable failure!!

Since my origional dr. never explained the differences in surgeries, I'm not sure I made the best decision.  He moved to Seattle after my 1yr goal and basically, I was left out in the cold to fend for myself.  Since then, I have relocated to FL and none of the "regular" drs or the gastro drs know anything about bypass.  I had an EGD a couple of years ago b/c I told her something wasn't right that my food didn't seem to be moving along as quickly as it used to.  She said I was fine.  Well now that I'm researching revision, I'm thinking that she didn't know what "fine" meant to a bypass patient and should have sent me to a biatric specialist.

How in the world can you convenience your insurance to cover a revision if they don't cover bypass surgery to begin with?  I read one story where it took someone 2 years for approval.    I can't afford to have any surgeries without insurance.  Am I just SOL again?  
Thanks for any help you can offer :)
Ladytazz
on 6/20/12 4:45 pm
Chances are if your insurance doesn't cover WLS they won't cover revisions.  There really isn't anything that can be done about it.  When your employer purchases insurance for his business he has an option to include or exclude certain things to save money and apparently they excluded WLS.  Maybe next time there is open enrollment you can see if there is another option.
I went through the same thing with my first surgery.  I lost weight effortlessly the first 2 years no matter what I ate but right around 2 years the magic was over and since I didn't change my eating habits the weight came back.  Malabsorption decreases after a few years and all you are left with are better eating habits you may have developed.  I've been there, I know.
I developed a lot of problems and finally decided I wanted my surgery reversed since I had no benefits and a lot of problems due to it.  My surgeon told me that it couldn't be reversed, only revised so I decided to make the most out of my second chance and made the lifestyle changes that I needed to, with the assistance of my now working again tool.
In the meantime maybe you can see if your insurance will at least pay for a consult with a bariatric surgeon who can go over the results of your EGD and tell you if your pouch or stoma has stretched.  If not then a revision wouldn't really benefit you anyway.  Your tool is working, it is up to you to use it.  If there are mechanical problems you can always see if you can appeal your insurance company.

WLS 10/28/2002 Revision 7/23/2010

High Weight  (2002) 240 Revision Weight (2010) 220 Current Weight 115.

Turtle Lynn
on 6/22/12 12:36 am - New Castle, DE
RNY on 05/29/12 with
 
I have to agree with LadyTazz. . . . .if your employer has a WLS exclusion, anything bariatric isn't going to be covered, complications, mechanical failure or not.  Other insurance options at open enrollment may be your best bet, or trying to get a personal insurance policy on your own, but I have no idea how much that might cost you.  

I wish you luck, I know how frustrating that is.  I had to wait 3 yrs for my revision because my previous plan would only pay to take the Band out, they would not cover revising me to another WLS and I was determined to do it all at one time.

  HW 287, GW 150,  CW 168   ** Band to RNY 05/29/12 **

Starting BMI between 35 and 40ish? Join us-Lightweights Board

 

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