RNY to DS still on the road.....

I also posted this on the DS board

As some of you might already know me, I am seeking a revison from my RNY back from 2002 to a DS.  I have been working with Dr. K's office down in California for a year.  I live up here in Alaska.  It has been a long road since last January, when I finally admitted to myself, that I had gained back half of my weight from my RNY and I was miserable and blamed myself for failing.
I was "on the fence" for a few months, when I originally went back to see my PCP on a regualr basis, last January.  He started weighing me monthly & put me on phentermine.  About 2-3 months and MUCH, MUCH research later, I decided I wanted to try working towards getting a revision from my RNY to a DS.  My PCP has known me sice before I had my RNY, when I was over 300 pounds.  Here is a picture:


Anyways, he has seen me good, bad & ugly.... I had RNY right after I turned 30 years old.  Here is another picture of my journey:


The one from 2003 is after I went back down to Washington and had a TT, hernia repair & gallbladder removal.                                     --> scroll picture over-->

I had started my re-gain in October 2003 & settled weight-wise at 230's in 2004 & have been "STUCK" there since.

So, here I am, it is 2010, I have been working with Dr. K's office, we did submit into the insurance companies (my primary DOES NOT cover weight loss surgery, heck, ANYTHING to do/help with weight loss -- my company that I work for is self-funded -- so I seriously doubt they would pay a penny) But, thankfully, it looks like my seconday insurance (DH's insurance) will.  But I need to be pre-approved, first.  So, we submitted, and they came back in early October 2009, with not a denial, but not an approval, either.... Here is what they wrote:
We forwarded you request to preauthorize revisional bariatric surgery for Jamie (Last Name)to the medical consultant for the Alaska United Food and Commercial Workers for an individual review.

After completing the review, the consultant has informed us that the submitted documentation does not support that revisional bariatric surgery is medically necessary for this patient at this time.  The consultant indicated that "There needs to be a through dietary log to assess the possible role of poor food choices and dumping syndrome in this patient with weight gain.  Additionally, this patient should be evaluated with upper endoscopy and/or contrast upper GI study to assess for a specific anatomic abnormality following a previous gastric bypass."

Since the proposed surgery was determined by the reviewer to not be medically necessary at this time, we will not be able to provide reimbursement toward the proposed surgery.

So, I have jumped through the hoops, gotten my EGD & Upper GI done & am just finishing up the food log to send down to California, for the 2nd insurance submittal.  Truth be told, I got SCARED, REALLY SCARED, (the failure of a 2nd weight-loss surgery, & you ALL know how ""WE ARE OUR OWN WORST ENEMIES"") not to mention personal things in my life sent me into a depression & that is just never a good outlook on life, either....

So, here is a picture I had taken last year to send down to Dr. K's office:



And, a current picture taken at the end of May:


I also check the DS board on a regular basis, as well..... feel free to check my profile, too.
-Jamie

Hi Jamie,   This road is a very long and tedious journey; I only wish I had researched everything before jumping on the band wagon. Anyway I will keep you in my prayer and keep me posted on your insurance issues. I am still waiting for the surgeon to order the test for to see what is going on with my pouch. Once that is done I will be half way there to a revision. I will keep you posted on my progress too. My next appointment is next month with the nut not going to be to much help for me but we will see.   Sophia

Thank you, Sophia!!!

We are both definately struggling, but we are also BOTH working on jumping through our hoops & sharing our frustrations of our journies together....... inspiring one-another!!!!


Keep on going!!!!
-Jamie