I just have a feeling...

...this is going to be a real rough road. I have done my research on doctors and have decided that I like the sound of Dr. Anthone in NE. He is one of the few doctors that have a lot of experience in RNY to DS revisions. The best part, he doesn't have a horrendous waiting list either. I got an appointment August 17th and since it is only roughly 6 hours from my house I will be able to drive there and back the same day if I want. So this will cut down on the amount of work I miss.

I called my insurance company (UHC) and found that they do cover WLS but I have to meet "clinical guidelines". What this means is that I have to have a 5 year documented history of being overweight. The question I have is this, I had WLS back in 2008, this should qualify for my recent weight loss or medically supervised weight loss, right? As far as 5 years ago, I couldn't tell you who I seen back then. I should be able to get the records from when my daughter was born back in 2002 but between then and 2007 I don't think I seen a doctor due to pure embarassment over my size. Not to mention I have read (creeping) that some people have had issues with the revision to DS because some insurance companies feel it is still investigational.

I just hope this is quick and painless. My first surgery was done with medicaid and I got my approval within a week after the paperwork was submitted. There was no hoops, no tricks, no nothing. Just approved and straight to the point. I hope I am lucky this time, because I feel that I was lied to about the procedure and was told this RNY would be the answer I was looking for and there was no other procedure that could offer the same benefits. Now I am seeing that I should have looked deeper into the DS to being with and this could have been avoided.

I'm sorry, right now I am just really venting more than anything. I hope I can come back and report that this was all for nothing...

Are you revising due to medical necessity?

Most insurance companies require proof that you were heavy for a certain number of years, and they want a 6 month diet, with monthly checkups. I didn't lose a damned pound during my diet (it was shortened to 3 mos because I was revising due to mechanical failure). It showed that my metabolism was shot and without intervention I wouldn't lose more. I won my revision because the band that was added to my RNY was causing esophageal erosion.

Get the exact criteria from your insurance company. Talk to the doctor's insurance coordinator and they should tell you what to expect.

I am not real sure at this point if it is medically necessary, but I can pretty much pinpoint when the weightloss stopped and when the weight gain began. I have done nothing differently, but suddenly I feel unrestricted and just different.

I had a BMI of 61.5 when I had the surgery done back in 2008 and now I believe I have dropped some but I am creeping back up. I am still in the super obese category, that never broke. I asked about the diet and the insurance company said they do not require that, but they want 5 years of obesity. I hope I can figure that out. I was without insurance for about 4 years prior to my surgery, so finding records is going to be extremely hard. I can go back to my daughters birth but I wasn't HUGE then, still overweight though.

I wish I would have known about DS back when I was looking into WLS. I did 4 years of research, but for some reason I was only looking at RNY. My doctor doesn't do it so she offered no assistance as far as offering other procedures. Not her fault by any means, but if I had known then what I know now...

I wish you'd cross-post this to the Main board, especially the last paragraph, about only looking at ONE surgery.

With United Healthcare you don't necessarily have to go through everything all over again. Depends on why you need a revision. If it's because you didn't lose weight then you have to meet the initial criteria but that doesn't necessarily mean more than the BMI requirement since you qualified the first time. If your revision is necessary because of a failure of the original surgery then there are no other qualifications.

Here's the pdf:
https://www.unitedhealthcareonline.com/ccmcontent/ProviderII /UHC/en-US/Assets/ProviderStaticFiles/ProviderStaticFilesPdf /Tools%20and%20Resources/Policies%20and%20Protocols/Medical% 20Policies/Medical%20Policies/Bariatric_Surgery.pdf

And the relevant paragraphs:

Surgical revision or a second bariatric surgery is proven for inadequate weight loss if theoriginal criteria for bariatric surgery (BMI, co-morbidities and patient selection criteria)continue to be met.

Surgical revision of bariatric surgery is proven for complications of the original surgery,such as stricture, obstruction, pouch dilatation, erosion, or band slippage when thecomplication causes abdominal pain, inability to eat or drink or causes vomiting ofprescribed meals.

Hello,

I have had the lapband for a little over ten years. I have had non-stop reflux and I am ready for a revision.

I am overwhelmed with the amount of choices and don't know where to begin.

Any advice.

I weigh 230 and I am 5'6

Thanks for any advice:)

Kim

I weigh 240 this morning (up another pound). I am 5'4" and am a candidate for a RNY revision from a band. It is so very hard to figure what is right for you. I am thinkign the RNY is my best bet. I'm attempting to eat like a long term bypasser. I'm so hungry it's not going well. But my psych suggested I try. So I'm trying.

Teri

PS My band is completely empty because of a slip.

I think a RNY would be the easiest for me to get but I still haven't decided. It seems the DSers are happier with their surgery.

My band is empty but I still have non-stop reflux. It has to go soon.