DENIED for a stomaphyx

Hello friends!

I was recently denied for a stomaphyx by Medical Mutual of Ohio.  I had a RNY in 2001 and got to goal. Since childbirth etc. I have gained most of the weight back.  When I had initially met with my surgeon to discuss my options, he had indicated that he would like to pursue the least invasive procedure possible.  I had a EDG and found that my pouch is still in tact, but the stoma has stretched out.  Pouch being in tact would not allow me to have a Band - not enough pouch there.

Any suggestions would really help!

P.S. I thought about trying to appeal it, but I'm not really convinced that a Stomaphyx would be very effective...

Kristina

 Any indication of why they denied?  You might want to find out so that if you do choose another procedure you will know what you have to fix so you don't get denied again.

I agree with you on the stomaphyx,  But that and the Rose are not getting a lot of good results for many.  There is another procedure I have heard other talk about on this site called the skelatherapy (sp?).  It is were they go down through your throat and inject a substance around your stoma to create scar tissue.  This helps close the stoma out.  You might need 2 or 3 applications of it depending on the size of your stoma and body make up.  Perhaps this is something to look into.

I had RNY in 2001 and like you, gained a good deal of my weight back.  I have since had a revision to ERNY and am loosing again!  Woo Hoo.  However, it is an evasive surgery.  There are a lot of options out there.  

Good luck to you.

Hi! Can you tell me what an ERNY is?  Never heard of that one.
Thanks,
Jennifer
Lapband 7-6-06
Prope 339
Current 220
Goal??? ( be in sz 16 by Christmas)

Hiya Jennifer!
An E Rny refers to the length of the common channel.  When someone has a gastric bypass, the surgeon bypasses a certain amount and then shortens the common channel...think of the bottom part of the "Y"......to a certain measurement.  Proximal, medial, distal or extended.  Some surgeon's just lump them together and say a proximal or a distal.  The shorter the common channel (extended Rny or affectionally called an Erny) the more malabsorption there is and higher  chance of losing weight.

Many people are opting for this as their revision option from a proxy Rny since to go to a DS may mean a very difficult; complicated surgery for them and to go to a band over Rny may not be aggrsesive enough.  The shortened common channel of an ERny is essentially the same as the shortened common channel of a DSer.

You can type in the SEARCH window about:  the ABC's of Revision by Dr. Schlesinger and it'll pull up some past postings of his that explains it much better.

Good luck!

Thanks for posting.

I believe that the denial letter said something along the lines of "Experimental Procedure."

I put a call in to my surgeons office to see what my other options are.

Thanks!

That is it in a nutshell.  I had stomaphyx and at the time I was not happy that I had to pay out of pocket, but now that I am scheduled for a band over bypass in Dec, I'm glad that stomaphyx wasn't used against me.  If the insurance company had paid for stomaphyx (which DID NOT WORK) they would have given me a harder time in getting my band.

Believe me stomaphyx is not worth it!  Also, it IS experimental.

I am trying to decide if I am willing to pay out of pocket for stomaphyx.  Did you not loose any weight at all?

I lost a total of 17 lbs on the liquid post op diet.  Once I started eating real food again, I really had no restriction and gained it back PLUS more!!