peer to peer with BCBS denied my distal rny revision

BCBS has denied my distal rny revision x2. I was so upset earlier today when I got this news. Now, I'm ready to fight back. My next step is an appeal. I need advice from people that were successful with their appeal. I need all the help I can get, lol

For those that have DS, my GERD is why I'm chose a distal...but I haven't closed the door on a DS. I've had GERD for over 20 years and it did improve after my RNY, but now it has worsen as I've gain weight. I also had some urinary incontinence, which resolved with the weight loss and now has resumed with weight gain. Most of my weight gain has been abdominal, and I'm sure it's the pressure that has made both GERD and UI worse. (my volume of food has not changed, I eat around 10 oz).  

Is there anyone with a DS that had their GERD improve after weight loss? (I would treat my sleeved stomach the same way as my pouch, by meassuring my food) The closest surgeon that does these revisions is 5 hrs away in Va.

I appreciate any feedback.

I'm sorry about your denial, but brush yourself off, and hang in there.  In the hands of the correct surgeon it is possible to have a DS with GERD.  The great thing about the DS it can be customized, again in the correct surgeon's hands, not a DS surgeon who does a cookie cutter DS.  In the case of GERD the DS surgeon should modify your limbs appropriatly to compensate for a larger sleeve.  A larger sleeve is necessary with GERD as not to increase pressure etc.  You need a DS surgeon who takes your whole case into account and modifies you appropriately.  I would much rather keep my pylorus at any cost, and before I had the DS (revised from lap band) I have irreversible permanent damage, GERD 10+ years,  was the least of my complications,  to my esophagus, so yes you can have a DS, in the hands of a very skilled DS revision surgeon. In the hands of the wrong surgeon, it would be a nightmare.  PM me if you would like more info. and good luck with your revision, whatever you pick. 

Depending on the nature of your insurance coverage, you may still have appeals rights that have not been exhausted. You need to get a copy of your EOC (evidence of coverage) which is a lengthy document that will include info about what bariatric surgeries, including what types of revisions if any, are covered, as well as your appeals mechanisms.

I will send more info in a pm.

Larra

Prior to my DS, I had such horrible GERD that most nights I slept sitting up. This was back in 2003, 11.5 years ago. Back then, most surgeons made larger Sleeves than most do today. I credit my larger Sleeve---my surgical notes says it was left at 4-5 ounces---for the total CURE of my GERD.