Anatonic problem? (Sp)

My insurance is willing to let see another doctor and approve the DS surgery once I have completed the required testing to prove that there is a problem with the original surgery. I don’t understand if it isn’t working for me then it isn’t working what other proof do they need? Can someone please help me understand what this means? I really want to have a revision but need addtional help.

Sophia

Most insurance companies will only let you get a revision for a "medical" reason, it can not be that you just didn't lose enough weight.  I guess they are afraid that the Dr. who wants to do your surgery may make it seem like there is a problem when there's not and they don't want to pay, so they make you prove it.  Nice, huh?

Well I guess I will have to jump through the hoops for now and see if there is something wrong.I know that I don't get full like I use to and that when I do get to that point I can eat more after 5 to 10 mins. I will just have to wait and see.

they probably want you to see someone who can do either an upper gi or an endoscope on you.  the upper gi would show how fast food/liquids pass through your stoma and pouch, and with an endoscope they are able to get measurements of the pouch/stoma and check for staple line problems. 

the upper gi really didn't say much for me...just that liquid 'flowed freely' through the gastric pouch.  it was the endoscope that showed that my stoma was massively dilated and my pouch was slightly enlarged

they also found the cause of a lot of my pouch pain - which was a staple and sutures that had came undone and were 'hanging out' inside my pouch.   it wasn't enough to be considered a staple line breakdown, but the measurement of the stoma is the evidence i am using to try to get an approval for revision.  with measurements and other problems documented, it shows that there is a 'reason' the surgery isn't working for you.

sorry for the low-caps..my shift key is messed up. lol.

Well the flow issue might get it for me then I don't know how large my pouch is so getting these test done my just do the trick.

Thanks,

yeah, it sounds like a stoma thing.  i still don't eat much at one sitting, but 20-30 min later i feel like i'm starving...lol.   it's like i have 'some' restriction, but it goes straight to my intestines so i don't feel full for very long.  i think by the time i've added up all of the 'little meals' i eat during a day, it's probably close to what a person who hasn't had surgery would eat.   i have to pretty much stay on a strict diet just to 'maintain' and i'd probably have to starve myself if i wanted to actually lose weight at this point. 

Me too, the thing that just ****** me off was I watched what i ate, worked out 1 1/2 to 2 hours 6 days per week and lost about 10 pounds per month. Right now exercise isn't helping eating 3 meals and protien shakes don't do what they use to do. I have heard that as long as you have anything wrong they will aprove the revision surgery so i am hoping for the best. I remember when i could sip water and stay full off of that... Now i can dirnk a 16 ounce botte in about 10 to 15 min and then get another one. I am hoping for the best at this point but just to hear that they will approve it means more to me than anything else right  now. Well almost anything else. :)

I just wanted to say that I have Blueshield of California Netvalue and they paid for my revision, but it wasn't a ds. I work for the State so I don't know if that matters as well. I'm in Sac too. When I had my upper gi and endoscopy the only thing the surgeon said is that my pouch was a little big for how far out I was, but it didn't look bad. He still submitted for a revision because I had stopped losing weight after 6 months. I think it just depends on how the surgeon words it. Good luck to you.

Monique

Hi Monique,

I work for the State to I have an HMO so I don't really know if it matters or not, I will soon fine out. So what type of revision did you have?

Sophia

Mine is an HMO too. My surgeon just bypassed about 200 more cm of intestines making me a distal and he made my pouch a little smaller as well or at least he said he did.