Here we go again...

I was here a few months ago when I had a hernia, and was being pushed for a revision by my GI. Here I am again with severe abdominal pain (from complication during hernia with mesh repair) and GYN pain. GYN says he wont fix GYN issues because he doesn't want to ruin General surgeons work, General surgeon won't go in because he says my severe anemia and still being overweight aren't worth the risk. MY PCP is just desperate to get me out of pain, and at a healthy weight.


My only option in state is a Doc not very fond of here in the OH world, so we will leave him nameless. My PCP has the idea that if he refers me for Bariatric Followup care to this surgeon, and this surgeon approves me that HE will then be willing to go in and fix this hernia, and possibly revise my current RNY.

I have read general standards for revision, exisiting co morbiditities(all of my pre op ones are gone but now I have severe anemia), lack of weight loss (started at 327 I am at 216), and or complications (abdominal pain)

But can anyone tell me specifically what most insurance companies are looking for as far as requirements for revision of any kind? This doc is known for doing ERNY, or Sleeve (he does the DS also but I know the opinions here on THAT  lol).... Anyone have any insight if he decides to revise what criteria I would likely be looking at?

1st you need to have complete faith in the doctor that you choose or this new dr could really mess you up.  don't go with a dr just because he will go head first into revision. 

DO NOT HAVE SURGERY WITH SEVERE ANEMIA!!! work on this immediately.  do iron infusions, whatever you got to do!!!

most of the time the insurance is looking for lack of weight loss and still having co morborbidities

the doctor also would need to have a reason for revising.  When i revised from the lap band to RNY it was mainly because of the heart burn and lack of weight loss.

I just finished an infusion so Iron is stable. My hernia repair was done while I was in need of transfusion and I will not allow that again, so thank you for that I take it to heart. My PCP is suggesting revision for my anemia repeating itself so easily, lack of weightloss. I don't even know if this doctor will take me on as a patient. I had to submit all of my records, and a letter explaining my situation and will be called if he chooses to take me on I guess

 You have to make sure to ready your policy carefully. My CIGNA policy specifically states lack of weight loss is NOT a criteria for revision. I have a band and I have to show mechanical faulire of the band. Of course, mine's working PERFECTLY! 

You need to contact your insurance company and find out what their criteria is for a revision.  They are all different so it would be hard to hazard a guess.
What is your current BMI?  Many insurance companies go by the original requirements for WLS, BMI over 40 or over 35 with 2 or more comorbidities.  I'm not sure what your height is but if you needed to lose, say 200lbs to reach a normal BMI and you lost over 100 they consider that a success that you lost over 50% of your excess weight.  Sucks, doesn't it?
Have you had any testing to see the status of your pouch and stoma?  Sometimes if those are messed up they can be considered mechanical failures and a revision can be done for that.

I am 5'4", 216 as of home scale (214 at the PCP today). So BMI of 36.7ish. I started at 327, not sure how to figure out the percentages LOL I haven't had any tests done, I haven't been able to see a Bariatric specialist since 9 months post op when I found out I was pregnant. Dr Fang told me to follow up with OB only, and mid pregnancy I lost insurance so post baby I could no longer see Dr Fang for any care. A general surgeon did my hernia repair and said he didn't know what he was looking for to see if pouch was functioning.... Was a big mess and jerk of a doc.

Do you have insurance now?  If not a revision could be very spendy, not to mention the chances of complications are greater with a revision.
According to your BMI 50% of excess weight lost would be around 90 lbs so technically you aren't considered a WLS failure although I am sure you feel like one.
If you are insured then the first step is to see a bariatric surgeon and get the needed testing done to see where you are at with your pouch and stoma.  You could have stretched out your pouch or stoma or even had them done incorrectly the first time.  You need to check that out before you decide which way to proceed.  If there is no mechanical failure or comorbidities then you have the choice to either self pay or make the best of what you have.