pre op B.S please tell me
Hello, you are having another procedure which is going to be different. Having the psych evaluation gives you an opportunity to explore your own mind and preparedness. The nutrition class gives you information about your needed food supply. All of this is for you, to better you and support you. The health insurance companies all have their requirements. But in the end if you chose to become more knowledgeable you ultimately help you.
StacysMom
on 10/11/09 2:28 pm
on 10/11/09 2:28 pm
You didn't mention what exactly is being done for your revision.
If the surgeon is just "fixing" the old surgery (i.e., it will work exactly as before - not adding or subtracting anything), you really shouldn't need any of these things. If that is the case, perhaps the insurance code being used by the doctor's office for the revision is leading the insurance company to believe that you are changing the very nature of the WLS and that is why they are requiring these things. Or, your insurance automatically tacks on a nutrition and psych consult for any WLS related thing, in which case, it's a requirement and there's no way around it.
If you are indeed changing the type of surgery (i.e., adding a malabsorptive component like RNY, or changing the size of the pouch to make it smaller), then you will need the nutritional consultation because your body may have different nutritional requirements and it's even more important because you are a vegetarian. The psych consultations are important to prepare you for the changes in your life which will be taking place after the new WLS.
Good luck!
If the surgeon is just "fixing" the old surgery (i.e., it will work exactly as before - not adding or subtracting anything), you really shouldn't need any of these things. If that is the case, perhaps the insurance code being used by the doctor's office for the revision is leading the insurance company to believe that you are changing the very nature of the WLS and that is why they are requiring these things. Or, your insurance automatically tacks on a nutrition and psych consult for any WLS related thing, in which case, it's a requirement and there's no way around it.
If you are indeed changing the type of surgery (i.e., adding a malabsorptive component like RNY, or changing the size of the pouch to make it smaller), then you will need the nutritional consultation because your body may have different nutritional requirements and it's even more important because you are a vegetarian. The psych consultations are important to prepare you for the changes in your life which will be taking place after the new WLS.
Good luck!
Interestingly, my revision surgeon said that I did not need the psych exam, but when everything else was done and ready to be submitted to insurance, the insurance person in my surgeon's office said that I did need the psych exam to get approval. I was just denied by my insurance company (two months after submittal and one request for additional info later), so not sure if the doc was right or the insurance person was right. I'm optimistic about getting the denial overturned, though.
why do you ned a revision, i need one becaus of malfunction of th stoma( stenosis). i had the VBG vertical banded gastroplasty don 12 years ago. i wikk gtting the rny. im only170 pounds i actually gand some weight. but the doc thinks i will become underweight. good luck with the insuranc company. i wa denied the first time i hadto do a 2nd level appeal and apporoved. my old surgeon wrote a latter of neccisity and i and another r.n spoke on my behalf.
dostalj
on 10/19/09 12:18 am
on 10/19/09 12:18 am
I am in the "process" of getting my lap band revised to an RNY. Because my situation is chronic and not emergent, my program is requiring that I go through all of the steps as if I were a new patient (except for the weight loss). I'm okay with this.... although I believe that repeating the process is very systems oriented and not patient oriented. I already know the stuff because I'm 5 years post op.
It's okay... I understand that my team has to jump through insurance hoops to get me approved. I have had successful weight loss and my lap band has not technically "failed." (there is no slip or errosion). My body is simply WAY to sensitive to the band, and there is a definite intolerance intolerance involved. My body is rebelling against this foreign object.
Be well,
Jules
It's okay... I understand that my team has to jump through insurance hoops to get me approved. I have had successful weight loss and my lap band has not technically "failed." (there is no slip or errosion). My body is simply WAY to sensitive to the band, and there is a definite intolerance intolerance involved. My body is rebelling against this foreign object.
Be well,
Jules
You should find another surgeon if your current one is not willing to help. You would probably be a perfect candidate for Band over Bypass, but I'm sure there are other options available to you as well. I have seen tons of people post that they got revisions approved because of an enlarged stoma, but not sure how insurance deals with that. It is my understanding that as long as there is a medical need for the revision due to a mechanical failure, you should be able to get approval.
I had a Mini Gastric Bypass ten years ago. I have severe bile reflux that has caused Barrett's Esophagus. I also have delayed emptying of the stomach, severe anemia, and gastritis. My loop bypass is too high, so there is no way to stop the bile without lowering the connection. My surgeon wants to revise to a Rny.
Hope you get your revision. You have done really well with keeping your weight in check with the surgery that you have now. Good for you, as I have heard many people say that your current surgery is not really a great surgery (like mine). Oh well. Maybe we will both find a way to get "fixed" and converted to a more acceptable form of bypass. Good luck.
I had a Mini Gastric Bypass ten years ago. I have severe bile reflux that has caused Barrett's Esophagus. I also have delayed emptying of the stomach, severe anemia, and gastritis. My loop bypass is too high, so there is no way to stop the bile without lowering the connection. My surgeon wants to revise to a Rny.
Hope you get your revision. You have done really well with keeping your weight in check with the surgery that you have now. Good for you, as I have heard many people say that your current surgery is not really a great surgery (like mine). Oh well. Maybe we will both find a way to get "fixed" and converted to a more acceptable form of bypass. Good luck.
StacysMom
on 10/12/09 10:58 am, edited 10/12/09 11:00 am
on 10/12/09 10:58 am, edited 10/12/09 11:00 am
So, I see you ARE completely changing your surgery AND you are adding a malabsorptive component to it with the RNY. That explains the importance of both the nutritional and psych consults.
Because a solely restrictive surgery worked for you before, you may want to look into getting the sleeve instead of the RNY. You apparently do not need malabsorption to be successful with WLS. The sleeve (VSG) procedure is a restrictive only procedure where your stomach is made smaller and the portion of it which produces Grehlin (the hunger hormone) is removed. You would have a normally functioning stomach with a pyloric valve, instead of the pouch and stoma of the RNY (which can be problematic for some and lead to the necessity for more revisions down the line). You already have stoma problems, just from the VBG, but luckily you just have a band around there - your stomach was not actually cut.
Once you cut your stomach away from the pouch, it becomes a "blind" stomach which can't be scoped for problems in the future AND it limits the types of revisions you can have in the future, if you are unhappy with the RNY. Surgeons like to say it is "reversible", but it really isn't unless you go to the handful of surgeons in the U.S. who have the skill and experience to reconstruct the pouch and blind stomach into a fully functioning organ - and that's IF the pyloric valve actually works after having been taken out of the equation for years!
Not all doctors do all the different surgeries and doctors "sell" whichever surgery they perform, convincing patients that it's the "best" for them to have. Most of them "sell" the RNY because that is what they have the most experience in. Be sure and watch out for this and always do your own research. Don't just trust what some doctor is telling you.
The malabsorption of the RNY would require you to take extra vitamins, proteins and other nutrients and sometimes when patients slack off on this, there can be deficiency problems many years out from the surgery. That is why the nutritional consult is so very important for you to have if this is the surgery you decide you want!
Because a solely restrictive surgery worked for you before, you may want to look into getting the sleeve instead of the RNY. You apparently do not need malabsorption to be successful with WLS. The sleeve (VSG) procedure is a restrictive only procedure where your stomach is made smaller and the portion of it which produces Grehlin (the hunger hormone) is removed. You would have a normally functioning stomach with a pyloric valve, instead of the pouch and stoma of the RNY (which can be problematic for some and lead to the necessity for more revisions down the line). You already have stoma problems, just from the VBG, but luckily you just have a band around there - your stomach was not actually cut.
Once you cut your stomach away from the pouch, it becomes a "blind" stomach which can't be scoped for problems in the future AND it limits the types of revisions you can have in the future, if you are unhappy with the RNY. Surgeons like to say it is "reversible", but it really isn't unless you go to the handful of surgeons in the U.S. who have the skill and experience to reconstruct the pouch and blind stomach into a fully functioning organ - and that's IF the pyloric valve actually works after having been taken out of the equation for years!
Not all doctors do all the different surgeries and doctors "sell" whichever surgery they perform, convincing patients that it's the "best" for them to have. Most of them "sell" the RNY because that is what they have the most experience in. Be sure and watch out for this and always do your own research. Don't just trust what some doctor is telling you.
The malabsorption of the RNY would require you to take extra vitamins, proteins and other nutrients and sometimes when patients slack off on this, there can be deficiency problems many years out from the surgery. That is why the nutritional consult is so very important for you to have if this is the surgery you decide you want!
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