Update on Medical Insurance

smileyjamie72
on 4/20/09 7:18 am - Palmer, AK

I have been researching a revision from RNY to DS for over 3 months, and I want to say THANK YOU to everyone who has responded to my threads. But, I have been thinking about a revision, a WHOLE LOT longer. I also want to give you all an update. Unfortunately, my primary insurance does not cover anything obesity related. Here it is word-for-word: “Obesity. Care and treatment of obesity, weight loss or dietary control whether or not it is, in any case, part of the treatment plan for another Sickness. Medically Necessary non-surgical charges for Morbid Obesity will not be covered." IMO that is just a crock of **** But this is the hand that I have been delt. I do have a secondary insurance through my husband, and here is his plan exclusion word-for-word “No medical benefits are payable for: Services which are primarily for weight-loss." I have been seeing a PA since January, and am on a diet where I go in and get weighed in every month. I have another appointment tomorrow. He put me on Phentermine back in January. I have lost 10 pounds so far. I think I will discuss a future EGD and GI series with him tomorrow too. I have been researching surgeons on the west coast (I have family in California, Nevada, and Oregon), who do revisions, since I know that I will have to travel outside of Alaska. I understand that if I do have surgery, I will more than likely be out of state for 3 weeks or longer. And, if my husband’s insurance does not cover me, I will definitely be looking HARD into going to Mexico. Here is a list of doctors that do RNY to DS revisions, that I have compiled. Any feedback and information is welcomed!!!! - Dr. Jossart in San Francisco - Dr. Cirangle in San Francisco
- Dr. Rabkin in San Francisco - Dr. Keshishian in Glendale, southern California Charges $4,000. Out of pocket. - Dr. Crookes in Los Angeles, southern California - Dr. Ungson in Mexico - Dr. Baltasar in Spain - Dr. Deveney in Oregon The last doctor, I am just tossing around that idea, because I have family in Oregon too, but, not too keen on the idea of recooperating there. I also know that most of the time, when I post something, I do not articulate my point well, SORRY!!! I am posting this on the Revision and DS board.

Any feedback, info, etc. All welcomed!!!!
-Jamie

RNY 2/26/2002                           DS 12/29/2011
HW 317                                     SW 263 BMI 45.1
SW 298                                     CW 192 BMI 32.9~60% EWL
LW 151 in 2003
TT 4/9/2003

Normal BMI 24.8 is my GOAL!!!

GBP (RNY) 2/26/02 298 lbs, TT 4/9/03 151 lbs, DS 12/29/11
HW 317 SW 263 BMI 45.1/CW 192 BMI 32.9/GW 145 ~ Normal BMI 24.8
**Revision Journey started 3/2009 Approved 12/12/11**

mskay
on 4/20/09 8:57 am - chicago, IL

hi i'm looking to have revsion surgery also. i went in last week to see a surgeon here which i have a hernia and my connection from my pouch is loose so thats why i have little restriction now. the price he gave me was 15,000 cash and he's will go in and remove or fix my hernia then repair my pouch connection. he didint mention anything about upgrading to another procedure. so what is the $4000 out of pocket expense for with the doctor you mention.because i'm self pay because even if i had insurance he claim he's out of network so the insurance company will send the check to me. so i can take out a loan and pay him and when i get the check pay the loan backand the amount he's asking for is kinda steep to me.

smileyjamie72
on 4/20/09 9:56 am - Palmer, AK

DS on 12/29/11

The $4000.00 is an out of pocket expense that you give that doctor in advance. Something about money that the insurance company will not give him, so it is your responsibility.
(However, he charges a $4K fee upfront for revisions that are not covered by insurance.)

I am exploring my insurance options, not sure if they will cover anything, but glad that I posted, so I could get perspectives & responses.

GOOD LUCK!!!!
-Jamie

RNY 2/26/2002                           DS 12/29/2011
HW 317                                     SW 263 BMI 45.1
SW 298                                     CW 192 BMI 32.9~60% EWL
LW 151 in 2003
TT 4/9/2003

Normal BMI 24.8 is my GOAL!!!

GBP (RNY) 2/26/02 298 lbs, TT 4/9/03 151 lbs, DS 12/29/11
HW 317 SW 263 BMI 45.1/CW 192 BMI 32.9/GW 145 ~ Normal BMI 24.8
**Revision Journey started 3/2009 Approved 12/12/11**

JROLFSON
on 4/21/09 1:40 am, edited 4/21/09 1:42 am - St. George, UT

Dear Mskay:

The $4000 fee for Dr. Keshishian (whose home hospital is actually Delano, CA but he does revisions I believe once a week at Verdugo Hills Hospital in Glendale, CA) is for aftercare. So many times patients who have surgery from out of state do not return for post op care. By charging this $4,000 fee it's kind of an insurance policy to the Dr that you will return to get your $4,000 worth of aftercare. I'm sure it also helps line his pockets as well.

Hope this helps.

JRolfson

JROLFSON
on 4/21/09 1:41 am - St. George, UT

FYI:

Something I forgot in my last post to you is: Dr. Keshishian is one of the best revision surgeons from RNY to DS you will find! I was actually given his name as a referral from another renowned surgeon who does RNY to DS's.

JRolfson

smileyjamie72
on 4/21/09 2:57 am - Palmer, AK

DS on 12/29/11

That sure is nice to hear. That another surgeon reccomended him.

THANKS!!!

RNY 2/26/2002                           DS 12/29/2011
HW 317                                     SW 263 BMI 45.1
SW 298                                     CW 192 BMI 32.9~60% EWL
LW 151 in 2003
TT 4/9/2003

Normal BMI 24.8 is my GOAL!!!

GBP (RNY) 2/26/02 298 lbs, TT 4/9/03 151 lbs, DS 12/29/11
HW 317 SW 263 BMI 45.1/CW 192 BMI 32.9/GW 145 ~ Normal BMI 24.8
**Revision Journey started 3/2009 Approved 12/12/11**

Monique H.
on 4/20/09 9:01 am

DS on 10/15/10

Okay, maybe I'm reading this differently than you. It says Medically Necessary non-surgical charges for Morbid Obesity will not be covered. It didn't say that it wouldn't cover surgical procedures for morbid obesity, just non-surgical. I'm assuming that they are talking about diet pills and things like that. If I were you I would definitely call the insurance and verify. Also on your husbands it says for services that are primarily for weight loss, what if it is to treat you co-morbidities like diabeties, high blood pressure and cholesterol. Once again I would definitely contact the insurance and speak to someone or speak to someone in a doctor's office. Good luck to you.

WHEN LIFE KNOCKS YOU DOWN TO YOUR knees, JUST REMEMBER THAT YOU ARE IN THE PERFECT POSITION TO PRAY. HW 395, RNY 4/2/07 345, Lowest Weight 248, Revision to Distal RNY 1/13/09 278,Revision to DS 10/15/10

smileyjamie72
on 4/20/09 9:57 am - Palmer, AK

DS on 12/29/11

PERSPECTIVE, PERSPECTIVE!!!!!

Oh, a BIG THANKS to you, Monique!!!! See, I did not see it that way, I felt really defeated this morning, when I posted, Thanks for giving me new perspective!!!!

I appreciate it!!!!
-Jamie

RNY 2/26/2002                           DS 12/29/2011
HW 317                                     SW 263 BMI 45.1
SW 298                                     CW 192 BMI 32.9~60% EWL
LW 151 in 2003
TT 4/9/2003

Normal BMI 24.8 is my GOAL!!!

GBP (RNY) 2/26/02 298 lbs, TT 4/9/03 151 lbs, DS 12/29/11
HW 317 SW 263 BMI 45.1/CW 192 BMI 32.9/GW 145 ~ Normal BMI 24.8
**Revision Journey started 3/2009 Approved 12/12/11**

(deactivated member)
on 4/20/09 11:00 am - AZ

Revision on 12/06/06

On April 20, 2009 at 4:57 PM Pacific Time, smileyjamie72 wrote:

PERSPECTIVE, PERSPECTIVE!!!!!

Oh, a BIG THANKS to you, Monique!!!! See, I did not see it that way, I felt really defeated this morning, when I posted, Thanks for giving me new perspective!!!!

I appreciate it!!!!
-Jamie

It looks like an exclusion to me. To me it is listing all the things that are not covered including obesity related issues.

Is there more to that paragraph? Would you repost with the sentences above and below that section?

smileyjamie72
on 4/21/09 4:00 am - Palmer, AK

DS on 12/29/11

OK, here is a little more....... This is under the "Defined Terms" section: A little above, and a little below

Mental Disorder

Mental Disorder in the current edition of International Classification of Diseases, published by the U.S. Department

of Health and Human Services or is listed in the current edition of Diagnostic and Statistical Manual of Mental

Disorders, published by the American Psychiatric Association.
means any disease or condition, regardless of whether the cause is organic, that is classified as a
Morbid Obesity

shortened life span. The current clinical standard measure for Morbid Obesity is a BMI (Body Mass Index) of 40+.

The BMI is a factor produced by dividing a person’s weight (in kilograms) by his/her height squared (in meters).
is a serious disease associated with a high incidence of medical complications and a significantly
No-Fault Auto Insurance

reparations provision of a law providing for payments without determining

fault in connection with automobile accidents.
----------------------------------------------------------------------------------
And this is under the "Plan Exclusions"

Charges for nutritional supplements.
(24) Obesity.

part of the treatment plan for another Sickness. Medically Necessary non-surgical charges for Morbid

Obesity will be covered.
Care and treatment of obesity, weight loss or dietary control whether or not it is, in any case, a
(25****upational.

work for wage or profit including self-employment.

This is all just as it is written in my primary insurance plan booklet.

Thanks again, for making me look back at it.
-Jamie
Care and treatment of an Injury or Sickness that is occupational -- that is, arises from

(23) Nutritional supplements.
is the basic

RNY 2/26/2002                           DS 12/29/2011
HW 317                                     SW 263 BMI 45.1
SW 298                                     CW 192 BMI 32.9~60% EWL
LW 151 in 2003
TT 4/9/2003

Normal BMI 24.8 is my GOAL!!!

GBP (RNY) 2/26/02 298 lbs, TT 4/9/03 151 lbs, DS 12/29/11
HW 317 SW 263 BMI 45.1/CW 192 BMI 32.9/GW 145 ~ Normal BMI 24.8
**Revision Journey started 3/2009 Approved 12/12/11**

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