Appeal for revison denied

Hello Baileymouse,

Thank you for sharing!!  I had an endoscopy done and they found that I have an opening to the lesser curvature side of my stomach along with another opening to the greater curvature side, in other words I had a staple line failure prob during my chemo with all of my throwing up.

I came down with nonhodgkins lymphoma 2 mos after having the vbg done and the chemo did a number on me along with all the surgeries.  I throw up at least twice a day, my stomach will stop digesting, food will sit in my stomach for a couple of days, cant get anything up or out the other way...its agony.  I even throw up in my sleep.  My stomach hurts like I have an ulcer altho nothing came back abnormal during my barium and endoscopy other than he 2 separate openings.  I asked them if they could tell if anything was going wrong with the band, he said sometimes,  but not always.  I am back up to 40 bmi and would while yes I want to lose a few pounds but I REALLY want a normal life back.  I'm tired of smelling like vomit, or food getting stuck, feeling like it has claws as it goes down.  I'm doing another appeal, and it sounds like my doc may do a peer to peer.  I'm am so afraid that they will not approve this surgery and I will have to live like this forever.  Does it sound like I have a chance to you Bailey?
God Bless
Kimberly

Kimberly,

You have mechanical failure, and as such they should definitely grant you the revision. It's a medical necessity! You have been through so much, and to have them deny you on top of that would be cruel.

You need to have an appeal filled out, and worded correctly by a surgeon, pointing out that you have these very specific mechanical problems that are interfering with your quality of life. I wish you all the best!
Adele

Thank you so much Adele, you have brightened my day

Hi Everyone,   I’m new to this webpage/forum, and I’m desperately looking for some help and answers. I feel devastated and defeated after having my gastric bypass 3 years ago. At his point I have gained another 30lbs back and it is very difficult to loose them and I’m hungry all the time. I’m considering the ROSE procedure since my endoscopy yesterday showed an enlarged pouch and stoma. Anyone here who had the bypass revision surgery? I need to know if my insurance (Health Net HMO; California) will cover it!!   Pleaseee, any answers/advices would be highly appreciated!   Thank! Jessy

ROSE/Stomaphyx and related procedures that are supposed to endoscopically shrink the stoma are worthless.  Most people lose about 20 lbs on the enforced liquid diet post op, then gain it back.

And to my knowledge, no insurance covers it.

You should be considering a better, more permanent solution to your failed RNY - check out the DS, and since you're in CA, you are VERY fortunate to have two of the very few competent RNY to DS surgeons available to you, Rabkin and Keshishian.  Keshishian may be in network with Health Net; Rabkin does not contract with any insurance; however, if there is nobody in network competent to do it, then you may be able to force your HMO to pay for Rabkin.

Health Net is assholic about paying for revisiions; however, the CA DMHC is very pro-DS revision, usually.  So if HN denies you, appeal, appeal and then get an IMR from the DMHC.

I'm glad i saw this. Maybe more looking and i can find the answers. I had the gastric sleeve 3 yrs ago, lost barely half of what i needed to lose and now i have gained it all back. My bmi is now 51. Husband was in military when i had the surgery but since has retired and i'm not sure how i even go about getting a revision, who i talk to, where i go etc. We still live in the area of the hospital where i had it done but we were told we have to go off base for ALL our medical needs. So does that mean as a previous patient on base for the surgery i go elsewhere and if so, where or what do i do to find out about a revision? Is there a topic on this that i have missed or any help to point in the right direction?

Have you posted thi as a separate topic?  If not, I would!!!!!  That way it will not get missed in this post.  Are you considering a revision to re-do just your sleeve, or something with a malabsorption component?  If you are considering the second option, the best success rate is the DS.  Check out the DS board
http://www.obesityhelp.com/forums/ds/a,messageboard/

And DS Facts
http://www.dsfacts.com/



Honestly, reading this article "sealed" my decision for me to pursue a revision of my RNY to DS
http://www.dssurgery.com/about/publications/duodenal-switch- safe-operation.pdf





Good luck on YOUR journey!!!!!
-Jamie