Question for post to ERNY Revision Patients

Hi there.  I have a couple of questions.  I have Aetna POS and my policy states that my revision will be covered if a the patient was not successful with the original procedure.  The requirements include having a supervised diet.  I've been taking Phentermine since September '08 without much success. 

Questions:

***Did anyone take phentermine and provide that information to the Insurance Carrier?  I would think that being under a doctor's care and being prescribed phentermine for 6+ months whould be sufficient.  However, I would love to hear of your experience.

***Can ERNY revisions be done LAP? 

*** Laslty, how long where you in the hospital following surgery?

I had a consult in June 09 and after having a Endoscopy and an UGI the Surgeon informed me that my RNY was in tact.  He did not think an ERNY revision was necessary since I only have 80 pounds to lose.  His thought was that ERNY revisions should be for candidates who are 150 pounds or more overweight. 

Question: 

***What do you Guy's think of my arguement that although my RNY may be sound, small pouch and stoma, given I never lost to goal, surgery 12/2003, and regained weight that it was not successful for me?

I would love to hear from you all.  Since regaining weight I have devloped hypertension...I really want this taken care of as I have a strong family history of diabetes, stroke, colon cancer, etc.

Thank you!!!!

Tonya

My revision to the ERNY was done lap and I was only in the hospital for one day.

Good luck!
Tara

I am currently waiting on approval from BCBS regarding revision from RNY to ERNY.  What issues or problems did you or do you  have after your surgery.  I hope all went well for you.  Are you losing weight slowly or at a steady rate.

thanks so much for your answers.
Marianna

 Hi Ellton,

I would suggest calling your insurance company regarding their exact qualifications for the supervised diet.  Ins. companies all put their own spin on their requirements.

I believe any surgery can be done lap as long as you find a qualified surgeon and you do not have a ton of scar tissue to deal with.  

Mine was done open and I am glad it was.   The doctor found a ton of issues he cleaned up and I haven't felt this good in years.  Also, I would suggest that you get several opinions.  I had ERNY and only had 52 lbs to loose.  My surgeon looked more at long term success as well as total amount of weight to be lost.  I have a common channel of 75 cm.

I was in the hospital for 24 hours and released.  As long as I kept up on my pain meds for the first few days everything went extremely well.

Be careful on what argument you choose with your insurance....I had BC/BS and they stated point blank that they would not approve a revision if the reason was solely that you did not loose the intended amount of weight with your original wls that you had wanted.  Insurance companies can be funny.  Call them and ask for a list of their specific requirements before you choose what your argument is going to be.  ;-)

Good Luck to you.

NOt sure if Aetna has changed their  criteria ... Aetna paid my revision.  ..

 As I remember ....  in their  policy it had to be at least 2 yrs since the original surgery. and  you had to loose less than 50% of excess weight.  -- It was close  I think I made it by 25 lbs .  You can call and they will tell you the criteria -- Or where to find in online in their manual.   

Hi Tonya:

Well I had ERNY on May 20th and I will try and answer what questions apply to me...Here goes...

I didn't need to provide a 6-month diet because I had other issues going on other than weight gain so The Phertermine question doesn't apply to me...I had hernia and bowel obstruction repair at the same time they did my ERNY...

I understand they can be done Lap especially if your initial RNY was done lap...I had 2 previous WL surgeries and both were open so they did my ERNY open.

My hospital stay was barely 24 hours even though my surgery was quite extensive and I had full open...But that comes from having an experienced surgeon...

As far as ERNY not being necessary because you only have 80 lbs to lose...Ridiculous statement...I only need to lose 70 lbs but it's like trying to lose 100 to me...There are other ERNY'ers on this board who went in with only 30 lbs to lose...

The Dr.'s told me my RNY was intact and that my pouch was still correct size...But I know my stoma is enlarged either way I couldn't lose unwanted weight and my Dr. agreed I needed the ERNY to start the weight loss process...

Good Luck

Janie

Thank you all for the great response.  I have an appointment with Dr. Schlesinger on Monday.  So, we'll see.

Tonya

wooo Hoooo Tanya!  You're heading our way?  ....  Bring your swimming suit and give me a call and we'll throw some turkey burgers on the grill!!!  (Be prepared for HOT HOT HOT!!!)

Good luck with your Dr. S appt!!!!