Revision from RNY to DS and medicare
I was wondering if anyone know if there are any surgeons that perform RNY to DS revisions and accept medicare around Louisiana? I tried Dr. Stewarts office in Texas but they told me they do not accept medicare for revisions. If not around Louisiana who are the doctors anywhere that accept medicare for RNY to DS revisions and what are the requirements? I had a RNY in 2006 lost 190lbs then gained back 140lbs. Thanks for any info.
I'm sorry Dr. Stewart doesn't take your insurance for the revision you need. It is sad how little Medicare reimburses for a DS in general, let alone a megacomplex RNY take-down plus new DS.
I know of two cases of people who got the RNY-to-DS revision with Medicare. One used Dr. Keshishian in California, and the other used Dr. Greenbaum in New Jersey. However, I think Dr. Greenbaum is no longer doing this very complex revision (it may be a rule from the hospital where he was doing them). Dr. Keshishian is very experienced in this, and is highly respected on the message boards by long-time DSers. However, you should know from the start that he charges a program fee, I think in the $4k range for revisions. That fee is in addition to your deductible and co-pay, and in addition to what insurance covers. It is an extra fee to make up for the low reimbursement insurances pay for the DS.
Everyone loves to recommend Dr. Rabkin for the RNY-to-DS, but that is useless for someone who has Medicare, which Rabkin does not accept for any WLS.
If you cannot afford Dr. Keshishian, there is a possibility that Dr. Buchwald in Minnesota or Dr. Simper in Utah will take your case and Medicare, but they have not done as many RNY-to-DS revisions (although Dr. B. is old and very surgically experienced in WLS in general).
Medicare requires you to have a BMI of 35+, and to have co-morbidities, pass a psychological evaluation, and to have already tried dieting in the past. Whether or not you have to do a new supervised diet varies by surgeon and by which private Medicare administrative contractor has the contract for that region (it goes by the region where the surgery is performed, not by where you live). The doctor's office staff can tell you more specifically what Medicare requires there. For example, the practice where I go, says that Medicare patients have to have the MMPI (Minnesota Multiphasic Personality Inventory) be a part of their psych. eval. I don't know if that is 100% truly required by my region's Medicare contractor, but, you know, I figured it may be just another hoop my local practice used to weed out more people with the poorly paying insurance, but I just went along with what the practice required. (Same with me having to do the supervised diet, when I know Dr. Anthone's practice does not require that of their Medicare patients, as I called and asked his staff member. However, Dr. Anthone no longer does the RNY-to-DS revision.) Another odd requirement the practice I went with had for Medicare patients was the need to have tried at least 30 days of using diet pills, or to have a letter from the patient's PCP or a cardiologist saying that was contraindicated. My PCP provided about a 1-sentence letter of contraindication, but it fulfilled the hoop. I don't think I've heard of other places having that requirement.
I know of two cases of people who got the RNY-to-DS revision with Medicare. One used Dr. Keshishian in California, and the other used Dr. Greenbaum in New Jersey. However, I think Dr. Greenbaum is no longer doing this very complex revision (it may be a rule from the hospital where he was doing them). Dr. Keshishian is very experienced in this, and is highly respected on the message boards by long-time DSers. However, you should know from the start that he charges a program fee, I think in the $4k range for revisions. That fee is in addition to your deductible and co-pay, and in addition to what insurance covers. It is an extra fee to make up for the low reimbursement insurances pay for the DS.
Everyone loves to recommend Dr. Rabkin for the RNY-to-DS, but that is useless for someone who has Medicare, which Rabkin does not accept for any WLS.
If you cannot afford Dr. Keshishian, there is a possibility that Dr. Buchwald in Minnesota or Dr. Simper in Utah will take your case and Medicare, but they have not done as many RNY-to-DS revisions (although Dr. B. is old and very surgically experienced in WLS in general).
Medicare requires you to have a BMI of 35+, and to have co-morbidities, pass a psychological evaluation, and to have already tried dieting in the past. Whether or not you have to do a new supervised diet varies by surgeon and by which private Medicare administrative contractor has the contract for that region (it goes by the region where the surgery is performed, not by where you live). The doctor's office staff can tell you more specifically what Medicare requires there. For example, the practice where I go, says that Medicare patients have to have the MMPI (Minnesota Multiphasic Personality Inventory) be a part of their psych. eval. I don't know if that is 100% truly required by my region's Medicare contractor, but, you know, I figured it may be just another hoop my local practice used to weed out more people with the poorly paying insurance, but I just went along with what the practice required. (Same with me having to do the supervised diet, when I know Dr. Anthone's practice does not require that of their Medicare patients, as I called and asked his staff member. However, Dr. Anthone no longer does the RNY-to-DS revision.) Another odd requirement the practice I went with had for Medicare patients was the need to have tried at least 30 days of using diet pills, or to have a letter from the patient's PCP or a cardiologist saying that was contraindicated. My PCP provided about a 1-sentence letter of contraindication, but it fulfilled the hoop. I don't think I've heard of other places having that requirement.
There is no one around Louisiana doing RNY to DS revisions at all (except maybe Dr. Stewart), nevermind what the insurance is. You will need to travel.
Dr. Greenbaum in NJ does still do some RNY to DS revisions on a case by case basis. Only he could tell you if you would meet his criteria, and he would need things like your operative report from your RNY, maybe some current study of your pouch, that sort of thing.
Dr. Roslin in NY is a possibility.
Dr. Keshishian in CA does as many RNY to DS revisions as anyone, and does accept Medicare. As Nightowl said, there is a program fee.
Dr. Rabkin is excellent but does not accept Medicare.
Dr. Buchwald in MN does do some RNY to DS revisions, I have no idea what insurance he accepts.
You will need to make more phone calls, or start emails to these surgeons and see who fits the bill for you. Good luck!
Larra
Dr. Greenbaum in NJ does still do some RNY to DS revisions on a case by case basis. Only he could tell you if you would meet his criteria, and he would need things like your operative report from your RNY, maybe some current study of your pouch, that sort of thing.
Dr. Roslin in NY is a possibility.
Dr. Keshishian in CA does as many RNY to DS revisions as anyone, and does accept Medicare. As Nightowl said, there is a program fee.
Dr. Rabkin is excellent but does not accept Medicare.
Dr. Buchwald in MN does do some RNY to DS revisions, I have no idea what insurance he accepts.
You will need to make more phone calls, or start emails to these surgeons and see who fits the bill for you. Good luck!
Larra
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