Current "Ruined" RNY, Insurance Issues with revision

Had RNY 1/5/2010. Got pregnant at only 9 months out. I did lose during pregnancy but due to complications after her birth I struggled with emotional eating. I HAVE since gotten therapy and have a handle on my eating. However, in between her birth and today I have had a severe hernia repaired with mesh (still have pain from mesh puckering in one spot),  a 1cm polyp with cancer cell present removed, and of course severe anemia. during all of the testing for these things it was found my stoma is stretched, as is the pouch.

Last May I was 210, today I am 260. My eating is logged, and is on track. No matter what I eat, it sticks. So I called my surgeon, and he scheduled me for a consult. Called my insurance and she said they do not cover a second weight loss surgery but will cover a "repair".

My question is, what are viable options that actually produce weight loss that can be considered a "repair" and not a second surgery. They assured me Doctors and coders are very good at making sure to properly code what the insurance needs to hear.  Just wanted to see what this group new of as options. Can they "redo" the original surgery? Can they convert to a new version and label it a repair? I am just so tired of my eating on track and my scale umping in HUGE amounts (One month it jumped 30 pounds!)

If you're eating proper but still gaining weight, you've got a metabolic problem. Your best bet is getting revised to a DS, but there aren't a lot of surgeons capable of doing that. Here's a link to a list:http://www.obesityhelp.com/forums/revision/4599894/RNY-to-DS -revision-surgeons/

Hi,

A revision is a repair to a WLS that did not work. I can not tell you what to do but I recommend DS. I had a RNY to DS revision with Dr. Ara Keshishian in December. I would be wary of a revision to ERNY or a "RNY Tune-up" where they go in a "thighten" up and already small stomach. I have not heard of many long term success stories. Only you can determine what is best for you but make an informed decision. 

Best,

Whitney

They did offer the DS as an option, but I am not sure how they would code that as a repair and not a second WLS. The rep at UHC was very clear it has to be a repair not coded as revision. Such a pain!  Thank you!