Stomaphyx

My Doctor that did my first surgery in 03 did my revision in 06 and is the one who will do it this year if I can get it covered some  how with Ins.  I know it is so new but I am still willing to be the research patient if that will help me.

I am on medicare and also have a supplement and I ask if they would cover the sclerotherpy on the stoma and also do the endoscopy  as covered and both insurance told me as long as my Dr. ordered it, now see he is doing a procedure that probably is always covered (and that would be the endoscopy) which a lot of people have done to look and see it they have anything wrong with their stomach whether it be a pouch or a regular full stomach that has had NO surgery done on it to make it smaller they do the endoscopy to look to see if people have a cancer in their stomach also so it is not that hard to get the sclerotherapy coverd since the Dr. is alraedy down the throat with his tools and it is lsee invasive than the stomaphyX is what Dr. Scott told me, and I know he very well knows what he is talking about. This procedure is working for me .

My Dr never even mentioned that to me.  I will have to ask him about it?

ll when I first started reading about the stomaphyX I ask my Drs. nurse about it and she made me an ap. to come and talk to him about why I was not losing weight and that is what he suggested (the sclerotherapy)  he  said had a lot of good results with it and not as evasive as the stomaphyX is on a person

I just got an email from Pleatman today and he said he is set up to do StomaphyX and/or sclerotherapy, depending on what he finds. Sclerotherapy is to reduce stoma size; StomaphyX is to shrink the pouch.  Depending on what he finds he can do both procedures.  This is what I have been looking for.   I am 14 years post-op gastric bypass. I am finally convinced this is what I need and want  to do.  Just waiting to see my primary to order the Upper GI then I am off to Dr. Pleatmen for consult and surgery. I would also like to know what procedure code (CPT code) your docs are using in trying to obtain approval from from the insurance company for StomaphyX...even though insurance companies have been paying for endoscopy surgery it is based on the diagnosis and specifics on what he actually does.  Otherwise if the doc says he is doing one procedure and does another he can be charged with insurance fraud.  Insurance companies most of the time require operative reports before they pay as well.

I had stomaphyx on 2/1 and it was totally out of pocket.  I have read others on this forum that have been able to get this paid thru insurance, but I did not.  I'm trying to go back, get a denial from BC BS and then file an appeal...it's probably just a crap shoot.

Oh I totally plan on paying out of pocket as well.  Just thought I would run it by my insurance company and billers/coders where I work for ****s and giggles. So you are almost 3 months out, hows it been going?  Good/bad? 

Well, I don't think I'm doing great.  I have very little restriction if any, and am finding it very difficult to be motivated.

You just have to remember to keep your spirits high.  You didn't put on the weight over night.  Have you added exercise into your daily activities?  Try not to focus on the scale but on toning your body.  Remember muscles are heavier than fat.  I have teetered with the same 15 lbs over the past year and a half but have lost inches. I have had to buy smaller sizes. 

Thanks so much for your encouragement.  I have tried to analyze this from every side and still don't know why I can't just shut my mouth!!  I've thought a lot about revisions but realize on some level that a revision will give restriction and closing my mouth will also give restriction...duh!!!  Is so easy to just say "All I have to do is put less into my mouth". but that simplistic solution is so hard!  I was going to the gym and walking on the treadmill, but have had to stop for 3 weeks due to an inflamed tendon in my foot...so I can't seem to get anywhere.  I try so hard NOT to make the scale so important to me, but I seem to be unable to do so.  I am cursed or rewarded by the scale.  I know on one level that I need to just relax and stop letting the scale rule my life, but anyway that is my struggle. I have heard so many people on this forum talk about the DS but there doesn't seem to be many surgeons doing it...don't know of any in Connecticut, and doen't really know what the recovery time is, or really much about it at all. Anyway, I plod on...