My sister is in need of Help and Advice

Hello,

 

I am writing in behalf of my sister, she had Open - RNY back in 97. Back then they were not as aggressive with the size of the pouch or the length of 'Y'. She never had dumping, and could eat a very large portion, even though she lost over 120 lbs,  in the past 4 years she has gained about 90+ lb. back

 

Over the past 2 years she has been looking in to revision surgery but when she started she had Kaiser insurance and after months of back and forth trying to get them do do anything she realized that they wouldn't. - Even her original surgeon was part of Kaiser but they were just terrible to work with.

 

She has since has new insurance with HealthNet and back in March of this year has been seeing her internist who has been monitoring her for bariatric surgery revision she has been doing detailed food / exercise  journals. 

 

Back in May she went and met with my Surgeon ( and my niece - her daughter) who had the same surgeon to see if he would do the revision Band Over Bypass. She met with him and in short order realized that he did not do revisions, and since she was a prior open RNY and cesarian, she is not a candidate for LAP.

 

So she had been searching for another surgeon in the county (San Diego) that was in-network that met her criteria for HealthNet. She went to a new surgeon in July who specializes in Stomaphyx, but who also does Band Over Bypass. My sister had her do a scope to evaluate her pouch and stoma and indeed her pouch is much larger than an modern RNY patient. Stomaphyx would not be a long term success for her. And so she had decided to do the B-O-B. 

 

In order for her to get the surgery the surgeon required a six months program with her so she signed up and started the program - I went with her to these doctor visits and mostly it was her reviewing her diet and exercise and vitamin nutrition info - Now my sister has is actively being seen by two doctors.

 

My sister REALLY needed to get surgery done before the end of the year because  work was slow and she could afford the time off  - plus she had meet her deductible for the year. In November she went to check out other surgeon recommended by the support group she has been going to, because the surgeon she had was trying to have her consider Stomaphyx. She liked the other surgeon who was actually trained by the doctor she is seeing - however he is out of network and would be close to $18-20k that it would cost her after insurance paid. After meeting with him she knew that B-O-B was her best choice, so each meeting with her surgeon her goal - WHEN can we get this going. Each time it was a noted on her chart about getting surgery - and each e-mail and correspondence was regarding surgery and B-O-B. Getting a approval and date.

 

In December she inquired again but the doctor said - all the 'good' nurses and doctors are on vacation in December. So reluctantly my sister said 'fine' - January then can be the latest. Since she has put life on hold and has pushed back work so that she can get the procedure and have recovery time. 

 

Now we are in 2010 and a few days into the month she had gotten approval from the insurance company and they even had a tentative date of the 19th. My sister went and met with them again this time my brother -in-law (her husband ) went to the meeting . The doctor, reiterated that we just needed to coordinate with the Hospital and the "assistant" surgeon as they were having a scheduling conflict. But were looking seriously to have a date ANY TIME.

 

My sister had been on a doctor prescribed liquid and protein shake diet since January 1st. She has been very vigilant to follow this. She had another series of blood tests drawn on the 11th and the 18th and seen the Cardiologist a few days later and was given a letter of clearance for surgery. And went and purchased a few hundred dollars of vitamins and post surgery protein supplements. 

 

So my sister has had ALL the required test done - ALL the labs done - Seen all the other professionals and been cleared - Has an approval from the Insurance - the hospital even phoned her and wanted to schedule pre admittance and talk about payment of co-pay, and suggested she could charge the copay on a Credit Card, but she held back waiting for a 'confirmed date'.

 

On the 18th she got a call from My surgeons' office a new coordinator had found her file from way back in May on the desk and just following up. My sister told her that she has everything lined up and we should be getting a date any minute. The coordinator said my surgeon reviewed her file and that yes her pouch was enlarged and that we'd like to get the records from her surgeon. She was puzzled why he'd want them since he DOESN'T do OPEN B-O-B revisions, but she said she didn't know if he did or didn't and proceeded to request the records from her surgeon.

 

On the 22 she opens a letter dated the 20th from her surgeon. Which states she is being discharged from her care, due to "behavior/honesty/compliance" and is not related to medical indications which you may have for treatment. 

 

We are actually floored at this letter and that following Monday we drove down to the hospital for a Revision seminar that the surgeon was giving just to sit in the back and wait till it is over to ask her to explain the letter because my sister is extremely upset and we are all bewildered to this turn of events. But the insurance lady that they had at the front door would NOT let her in to the seminar or wait for the seminar to end to even see the doctor

and get a more thorough explanation. In fact my sister paid out of pocket over $700 (not covered by insurance ) for the back on track program and STILL has one more month visit due to her. 

 

We are convinced these turns of events were caused by the NEW coordinator from my surgeons office but nobody will admit anything, calls to her surgeons office are not returned. 

 

So here we are desperate to find someone who has any advice to find an HealthNet In-Network surgeon and hospital that will take the case, she has EVERYTHING ready and documented she has copies of EVERY test and would like to get this done ASAP. She is STILL on a liquid diet so that she can be "on-call" if some thing would happen. The primary issue is here we are and it seems all these 'tests' are done and we are afraid that they would expire and have to be redone - adding more expense to this already expensive process, since now we are in a new year and having to meet a new deductible. 

 

This impact is very stressful on the entire family. And we really could use a break.

 

Thanks for any advice.

 

Steve

 

wow Steve!  What a crappy hand to have been dealt!!!  But....good for you for representing and helping out.

Be aggressive!  ....  Here are a couple of ideas....

Post on the California board.  Use this weekend to research surgeon's.  There are a zillion Bariatric surgeon's profiles on O.H. WITH their contact information.

Be armed for Monday morning and put the entire family to work calling surgeon's to see who will take the HealthNet insurance that does NOT require a program fee (unless you can get the $700 back?)  Lawyer?

Call the hospital itself where your surgeon does surgery and give a condensed version of the story to see if they can override the "firing from the practice letter".  .....  Order a fruit bouquet or something and have it delivered to the office with an apology letter and brief note of explanation. Maybe killem with kindness? 

And.....consider bagging the BOB and checking into the DS!!!!  There are  a few successful BOB's on this site but a truckload of successful Revisions to DS. 

Good luck and let us know how it all turns out........  Kudos to your sister for staying on the liquid diet and all ready to go!!!! 

 

OK, i'm a 1994. Had to have a revision in 2000 due to staple line disruption,, common to the 90's era surgeries.

I would NOT choose BOB, for sure, if a full revision is available.

If you go onto the CA board, also go to the duodenal switch forum and ponder that choice.

Steve,
Check out www.dsfacts.com and www.duodenalswitch.com.  Don't let insurance drive what procedure she gets, otherwise she could be making a 2nd mistake.  My insurance wouldn't cover my RNY to DS revision so am having to self pay.  There is no way I would have considered a BOB - have seen so many people who've had the band who are unhappy and revising from that to other procedures. I've decided it's better to go into hawk for awhile and get what's going to give me the opportunity for the best long term results.

Dr. Keshishian is an excellent revision surgeon in Southern California and he's great about answering surgery related questions - he doesn't know anything about insurance, but he's got people on staff who do.   I suggest you read the websites above before you calling, they may bring up questions in your mind that he could answer for you or your sister.

Good luck,

Debbie M.

I had VBG April 2004 and it broke down and I was revised to RNY July 2009.  I too had an open surgery in 2004 but my surgeon did my revision LAP.  It can be done.  My doctor is Dr. Theodore Khalili and he is brilliant.  Don't settle for anything less than perfection when it comes to a revision.  Research, research, research!  It can happen.  Be persistant.  

Good luck!