New to this forum..have questions

Hello,

 I had a RYN in 2004 and just had a EDG done and they found three openings in my staple line, I do not have all the details yet, but what the GI dr said was that my food is going into my old stomach and I would regain my weight....now this was not a WLS Dr.   I no longer in the same state as my WLS Dr. however i spoke to him by phone he said w/out looking himself he could not advise me....anyhow I have put on 7lbs this year, I still feel like my pouch works as I can still only eat small amounts, problem is I get hungry very soon, of course I do not always make the choices on what to eat...

My question is what qualifies a person to have a revision is just the fistula and staple line dispution or does there have to be significant weight gain?  Does ins cover it, is it seen my ins as a weight loss or bariactric issues vs a repair of a fistula etc...another medical reason?  Anyway I am very confussed and feel lost...any info you have is great...I was self pay w/my RYN and I do not have another 21k for a revision.

Thanks
Melissa

Hi Melissa,
You probably need to check with your insurance and see if they would repair the fistula. It is usually considered a medical neccesity. Does your current insurance cover wls? If they do, then a revision to repair shouldn't be a problem. I didn't know if you had a different carrier than when you had the original.
Hope this helps.
Kim

Hi Kim,

Thanks for the response, I do have new insurance, it is BCBS and I think there is an exclusion in the policy that is why I am trying to see if there if it would be covered as another medical issue and not WLS related.

I will have to start doing some homework...

Thanks
Melissa

Think you might have a an exception  or at least an appeal on that one ,, Since its mechanical failure  of the original surgery - I would think you could get ins to cover it ..   I am glad I dont have a staple line ...

Hi,

Thanks for the response, if you dont mind me asking why don't you have a staple line....what do you have?  What type of revision did you have done,?  

Take care,
Melissa 

OOOPs  my error .. I do have a staple / suture line ..

Not sure what I was thinking on that one - Sorry !

I had my common channel shortened to become more malabsorbtive.  Nothing done to pouch - cuz it was o.k. except for the stoma being open.

Hi Melissa

I BCBS of Georgia and I had a fistula also that is what got me approved immediately for my revision. I did an upper endoscopy the end of April. By May my Doc office was calling asking what day did i want to have surgery. I had a revision on June 17th 2008. Find a good Doc and they can lead you in the right direction.