I would like to ask for help. DS revision - Appeal Letter Assistance

OK, brass tacks here.  You don't say who your surgeon was, and that set off my hinkey alarm.  I went back through your posts and I think you don't WANT to say who your surgeon was, because it was probably someone not vetted and you were WARNED not to use - am I right?  You were bait-and-don't-switched, weren't you?  And told some ****and-bull story about complications and being too big for the lap instruments and blah blah blah, but in fact, you went to a surgeon who wasn't competent to do a DS, or at least not on someone of your size.  How could a surgeon not know in advance whether his instruments are sufficient for a larger patient?  Rabkin has instruments that allow him to do lap on an 800 lb man.

So, WHO are you thinking is going to do the switch for you?  The same surgeon who couldn't manage it the first time??  Whose name you are STILL not giving?

I think Diana's advice is spot on - you aren't seeking a revision, you are seeking the completion of an operation that was already approved and that, through no fault on your part, could not be completed for medical reasons. That is how both you and your surgeon need to present this to Aetna, and the right presentation could solve the whole problem.
     I don't know who your surgeon was either, but I share Diana's concerns on that front as well. If at all possible, get the switch done by an experienced DS surgeon...and you know who they are, or if you don't, check the list at dsfacts.com. The switch is the more difficult part of the DS. Also, the surgeon should determine how large your sleeve is to be sure it doesn't need tightening while he's in there.
     Oh, and an experienced DS surgeon will also know how to approach the completion issue with your insurance.

Larra

Larra, well put. 

I do think presentation is the key. 

I have been thinking of who i would use for the 2nd stage of the DS.   Your words of warning are right on point, and have reminded me of things that I learned when I was more active on these boards.

Thank you for your information and the mature delivery of that messge.  I am listening.  I might PM you with some questions if that is not too much trouble.

Have a good weekend,


T

I remember you. Good luck!

Thank you Emily....you have done so well!  congrats!