New, please help?

Hi everyone.  I'm new to the site and this is basically my last hope that someone out there can help me.  I had the sleeve a few years ago (08), got down to an XS, and now I ballooned back up for various reasons.  I am looking into having a revision to a Bypass and my doctor is on board and I had all the testing done….only the insurance denied my first request.  I know I have heard a lot of stories of people getting them to approve it but I seriously do not even know where to start.  The tests show my pouch grew, that I have a bad case of reflux & that I have a hernia at the start of my pouch.  I have Blue Cross Blue Shield Federal….was hoping someone could at least guide me in the right direction? I know I need this so if push comes to shove I'll have to shell out $20K plus but I would much rather have some guidance on the insurance side of things.  Thanks again in advance!

I don't know your insurance companies policy but generally you can get a revision if your surgeon deems it medically necessary.  My insurance paid for my revision due to side effects and also because my BMI was over 40 again and I had obesity related comorbidities.  Your surgeon's office should have an insurance person who can tell you how to appeal and hopefully help you do that.  If your insurance company has an exclusion for weight loss surgery or has a one WLS per lifetime clause you may be out of luck.  There is an attorney who advertises on OH, I think his name is Lindstrom, who has a good reputation in getting the insurance company to pay.

Also, if it does turn out that you have to self pay you might want to check into having surgery in Mexico.  There are surgeon's there who have good reputations and the cost is much less.  There is a forum on OH for WLS in Mexico where you can get more information.

Good luck to you.

Since you already have a Sleeve, you should really research the Duodenal Switch. The DS has the same stomach you have now, but adds an intestinal bypass similar to, but more effective than, that of the RNY/gastric bypass. The DS has the very BEST long-term, maintained weight-loss stats of all forms of WLS, period. You'd still have your pylorus, still be able to take NSAIDs, have very little chance of dumping syndrome or reactive hypoglycemia, and, if your surgeon deems it necessary, your Sleeve can be redone as well.

Both the RNY and the DS cause lifelong malabsorption of certain vitamins and minerals. The RNY causes slight malabsorption of calories for the first 18-24 months, but the DS causes permanent malabsorption of a significant per centage of the calories you eat.

Fixing that hernia would most likely cure your reflux. If your surgeon doesn't fix it, the odds are good that you'll still have it after the RNY as well.

I was wonder why you aren't trying for the DS.  As you have a sleeve which is the first step of the DS when done in two steps, have you considered doing the switch?  Some surgeons don't do the DS so don't recommend it as is the case at our center.  I was able to fight the once in a life time policy for WLS due to the medical problems that the band caused.  I don't believe I would have been successful going from a sleeve to another WLS as I wouldn't have been able to prove compliance and medical fault with the sleeve.