FEELING VERY DISCOURAGED!!

Hello,

Almost 5 years out from RYN...completed transceted but developed three gastro gastric fistulas which the Dr said is just as good as being completely reconnected.  I have gained 20lbs. 

Went to see a surgeon who is prepared to fix the fistulas make my pouch a bit smaller in the process. 

HOWEVER my insurance denied!!  I am feeling very scared and discouraged.  I was self pay for the RYN and my plastics, I do not have the  money to pay out again.  I feel like a total failure..so I am telling myself that I will work hard at loosing what I have gained, but have been reading about RYN folks being metobolically challenged and about the DS and the much better long term results with the DS.    

I am so frusterated with this entire situation.  My insurance has a weight loss claus and I have no idea if there is anyway around it.  I am so afraid that I will gain more and already find myself acting the way I did before surgery.  Avoiding seeing people, choosing clothes that hide my body, comparing myself to others. 

This is whining post I know, but I am just beside myself!

I understand completely about the poor self image.  You should check out the DS board, and post a few questions over there.  (But, you should say RNY... when you post )  Just because, that is how people refer to it as.

You are more than welcome to check out my profile too.  I am close to submitting into my insurance, but not holding my breath for an approval.


Keep your chin up!!!!
-Jamie

ha ha that is funny,  you know in my head I say RNY but I think I always typed RYN..hmmm.

thanks for the status!

I also forgot to mention.... that I have seen LOTS of insurance HELP, and information about insurance appeals, and just good tips on the DS board.

(and... I have witnessed posts & replys abut the RYN vs RNY thing... some of them were pretty rude... just my own opinion)

  Keep POSITIVE!!!!!!
Infromation & Research are GREAT tools!!!!!
-Jamie

Gosh my head is really in the clouds today...I just read my last reply to you..and I said thanks for the status, lol...I meant thanks for the support. 

Do not know why anyone would be rude about RNY or RYN but I have seen some pretty nasty stuff on these boards,  very silly in my opinion. 

Anyway I will hit up the DS board for insurance help..thanks for the information.

I am trying to stay positive...not a great day though, tomorrow will be a new day~

Oh, Melissa, I am so sorry to hear of your situation.  How scary to have gained 20# !  You know where this will lead. How can your insurance deny a fistula repair?  I can understand if your insurance denies a bariatric surgery, but a fistula repair?
Can you talk to the surgeon and ask her/him how the request for approval was coded?  Was it coded as a bariatric procedure?
Other than weight gain, do you have any other problems attributable to the fistula?  If so, that should help your case.  Please let us know.....

Hello,

I am not sure how the letter was written but what I do know is that there is no code for a gastro gastric fistual, there are codes for other types of fistulas but not anything specific to the two stomachs forming fistulas.  The Dr's office knew that it would be tricky to get insurance approval so they were golng to work on writting the letter just right...go figure!  Anyway the Dr. Office will call me tomorrow to let me know what next as far as insurance goes.

As for other symtoms I really do not have any, I occasionally get a horrible pain in my lower left abdomen but I had a hernia repaired and I think it the hernia that is bugging me again. 

My husband is no help either...his response was that I should just exercise and eat better and maybe the 20lbs would come off...UGH!!!!!  He of course is 5 ' 10" weighs 165lbs and that only cuz his arms are pretty muscular, otherwise he would probably weigh 150lbs, lol...plus he eats whatever he wants whenever he wants. 

Boy I am in a bad mood....

Thanks for giving a place to vent!

Melissa

44.63 Other Repair Of Stomach: Closure Of Other Gastric Fistula?
Good luck........

Thanks!!