rejected

Well my insurance- Tricare - rejected my request for a revision. I don't have all the details since Dr. Shoen's office manager didn't. I am really bummed. I had hoped this would work for me. Once I get the direct ino on why, I am going to try and find another surgeon in the area that does revisions and accepts Tricare (if there are any) and see if I can appeal. There is one part of me that is pretty sure that some of the reason for the denial is that Dr Shoen just plain does not want to do it. I don't know if it lack of experience, or he just doesn't think I need it - although, I do protein drinks exclusively, as well as maybe two cheese / peanut butter crackers with each shake since I cannot stand the after taste, I go to the gym and I get my 60 + oz of water each day. I have gained 100 lbs now since my goal weight after RNY. In the last week, I have gained 5 lbs! My resting metabolic rate is 1400 cal., I see a food psychologist and have done everything I know how, to change things.. I log everything, including exercise. So in a nutshell I do not understand why I do not deserve this opportunity. So I will continue to fight if I can.

I'm so sorry.  I'm in the same boat as you with the low resting metabolic rate. My revision hasn't been submitted to my insurance yet.  I plan to call my insurance (BCBS) tomorrow for clarification on the qualifications of a revision. I've done a 4 month diet using a dietician and diary, see the psychologist and labs. My surgeon feels I'm a good candidate. I want to know if there are any more hoops I have to jump through before my revision request is submitted.

I hope you can get the answers you need so you can appeal. I wish you luck.

Donna

Thanks.. I got to look at the rejection letter better today. The main thing it lists is that I have to have tried losing through standard ways, diet and exercise. Well I have been going to Dr. Shoen now for 2 years about this! I did not start any of these appointments because I was trying for or wanting a revision! I wanted to fix it! I have met with his dietitian more times than I can count, to look at and / or modify what I have been eating, I have done all the exercise I have been told to do plus some, heck, I went in and had a resting metabolic rate test to be sure I was under the caloric amount of daily intake! I have and do meet with the psychologist every month to go over all of this in a emotional and psychological way.. Dr. Shoen and his staff have been a part of this the entire time! And they didn't submit a damn bit of that info to the insurance company. So Tricare does not think I have done any of it..that does not sit well with me and most certainly does not improve my opinion of Dr. Shoen or his staff! 

So at this point, what I am doing- continuing my food monitoring (all 4 mini wheats in the morning to go with the protein drink) and my 4 peanut butter crackers for each of the two remainder protein drinks..my small dinner and my gallons of water...

I ramped up my workout to 2 hours today.. I was at one to one and a half, I picked up my strength training, and that horrid cardio.. 

And I am going surgeon shopping... I am going to file an appeal, after finding the doctor, if there is one, that will do a DS, to assist me in doing what ever needs to be done.. But I can damn well guarantee that it will not be with Dr. Shoen..he was not the surgeon who did my original RNY and he won't be doing my revision if I have one. 

Butterfli2005 I hope you are able to get the help you need. Did you have anything else to go along with the request? Any co-morbidities (high blood pressure or Diabetes) or other physical problems (GERD, esophagitis, etc) as well as weight gain? Sometimes the more one has going on the more apt they are to approve. I see Dr Schoen too and am supposed to be submitting to Tricare for a Band to Bypass revision. I'm afraid mine won't go through either because Tricare is so hard to deal with. When I got the band in 2009 I was rejected initially and appealed it myself and got it pushed through.