I'm new, but am having a revision!

candyshoe
on 11/30/07 2:44 pm - Kokomo, IN

Hi Sophie,

I'm sorry to hear about the problems from your first surgery and your insurance company not wanting to approve the surgery. Just keep on them and hopefully they'll approve it. Twice I thought my surgery was dead-in-the-water. They denied it the first time because they said I needed to go to my PCP for 18 months....so I did. After the time was up I called my insurance office and they sent me a bunch of stuff that I was supposed to have been doing, besides seeing my PCP....I was not happy. When I told my PCP, she sent them a letter stating why I needed the surgery (diabetes, high blood pressure, cholesterol, tryglicerides, ....and the list goes on. Then I got another denial, so I figured I was done. A few weeks later I got a letter stating that they have a 6 month program to go to and I had to sign a form saying that I would see my PCP 3 times; go to an appointed dietician for 6 months; see Psychologist 3 times & take a test; and go to a 12-week therapy group. All of this is in Indianapolis and I live in Kokomo, about an hour to 1-1/2 hours away(depending on where in Indy I had to go). I signed the form and did everything I was supposed to do, but then it took the Psychologist over a month to get my report turned in with my okay from her. I kept having people tell me I couldn't have it until next year....that was not acceptable because we will be on new insurance next year. So, as you can see, it's not been easy to get to where I'm at.

Did you have your surgery in NYC the last time? Is your surgeon still practicing? I am having the same surgeon as last time. Of course neither he nor I have moved....I take it you have? I hope that you can get this taken care of soon. I know how you feel since I've pretty much been there. Best of luck and keep me posted, please. I hope you will have good news soon. Candy

SophieGrace
on 12/1/07 8:59 am - IL

Revision on 02/06/08

Candy: Thanks for your reply. It's been a rough two years. My original surgery was in Memphis, TN. That surgeon retired around the time my weight gain started (suddenly, in June of 2005). This was right after my last hospitalization with intense stomach pain and high fevers (no fewer than ten doctors had seen me over the years since 2000 and failed to figure it out). The only reason I found out about my doctor in NYC was because of an investigational study being done to reduce transorally the size of the pouch and stoma. Once I went through the routine tests, including looking at my upper GI and endoscopy, it was glaringly apparent that I not only did not qualify but that I needed revision. In the endoscopy pictures, you can actually see staples hanging out. It's just lovely. Apparently my first surgeon decided to put in ONE row of staples, not the 3 I'd been promised. He must have had a tee-off time. I've been trying to lose weight for two years, seeing my PHP all along. To be honest, I don't have time to get jerked around by insurance. Besides gaining weight and being unable to lose it, I feel terrible -- my stomach has two huge ulcers due to the staple-line disruption, and I have random barf attacks. You can imagine how much fun that is. So as far as jumping through more hoops, if I'm denied I plan to sue immediately upon denial. I had to do this for the first surgery; it usually amounts to no more than paying the attorney a few hundred dollars, he writes a scary letter, approval comes shortly thereafter (it's usually far cheaper to pay for the surgery than it is to go to court). My PHP (who is herself overweight and totally not at all understanding about this issue) tried to warn me off, but I have a record with her of trying to lose this weight. Thank you for your concern. I came in here once the shock of finding out all this wore off. You should have seen me lost and alone in NYC trying to absorb the fact that I had a huge hole ripped in my staple line and trying to wrap my mind around the fact that I have to have another surgery that will be harder to handle than the one ten years ago. But I'm more than willing to do it, and fight for the right to do it because I want to live. I'll be in touch. Sorry for jacking the original thread!

candyshoe
on 12/1/07 1:51 pm - Kokomo, IN

Revision on 12/17/07

Hi Sophie, It sounds like you need a big break! That is ridiculous.....I can't believe you're having staples hanging around in there and ulcers and you're having this much trouble.

I can't say that I blame you for wanting to sue them if denied. The problem with insurance, is that you can't hardly make it without it anymore and they know it, so they tend to have us over a barrel....we are at their mercy, it seems.

I'll be praying that some way or another that you will get this surgery. Do keep in touch, please. Best of luck!!!

Candy

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I'm new, but am having a revision!

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I'm new, but am having a revision!