Rny to DS revision, on Kaiser, in So Cal, any luck?

shannon1891
on 12/27/14 2:28 pm - It Never Rains In Southern, CA

I've been struggling with weight loss since about six months post rny surgery. I did well before surgery, lost about 80 lbs, then about 120 lbs post op. But, with the need to get down from the high of 477 lbs, a mere 200 did not make my goal. Since then, I spent 3 years in the Masters program and graduated last May 2014. Working full time the whole time, being a parent, other things became priority, long story short, I'm back up about 60 lbs from my lowest, 270 lbs, and have not been able to regain control. While I take responsibility for my stuff, I do feel that there are medical issues with the rny such as severe constipation. I believe that my body has adapted to the bypass and severely slowed my digestion to compensate as there is no amout of fiber consumption that can ensure proper regularity (in 50-60 grams per day).

I've been thinking recently of pursuing a revision to the ds. I have Kaiser insurance and they're "strict" about not covering revisions, so I've been told. I live here in So Cal and have located a number of options in a 250 mile radius. The questions:

1. Has anyone has success with the rny to ds revision? If so, was it done as a two step surgery?

2. Has anyone had luck with Kaiser covering a revision? If so, did you need attorney representation and/or appeals?

3. Has anyone switched insurers to pursue a revision? If so, which provider has rendered success?

4. Anyone else have other helpful suggestions?

airbender
on 12/27/14 9:57 pm

I think rny to ds conversion would be the best plan for you. with your bmi it is the best long term durable WLS. you live in CA you have the best revision surgeon in the world in your back yard, Dr Ara Keshishian in Glendale and he does a one step DS. Look him up, be very careful who you consult for a rny to ds conversion, there are only a handful of surgeons in the world that can perform this. I hope you feel better soon, you didn't fail your RNY did.

no one will be able to answer your questions on insurance as they are specific to the plan that you have. see: http://www.obesityhelp.com/forums/insurance/5278075/Bariatric-coverage-Its-not-about-your-insurance-carrier-but/

shannon1891
on 12/28/14 12:12 am - It Never Rains In Southern, CA

RNY on 07/07/09 with

Thanks for the reply. I see the the verbage, conversion, that is tremendously helpful. I've been looking at Dr. Keshishian and I'm going to ask for a consultation. It's scary. Never thought I'd be looking to do something like this, but, here I am. I definitely need to get my policy and see what it says. Thanks again for the reply!

Mom2Noah
on 12/29/14 1:53 am - Bakersfield, CA

VSG on 07/05/12

I have Kaiser So Cal and am having a conversion from VSG to RNY with hernia repair because of my severe reflux. A DS would do me no good with the reflux to finish getting the weight off but I just had my surgeon put in for the conversion and all Kaiser required of me was to do the class over and see the surgeons in west LA and it was up to him if it was necessary but with all the issues I have had since my sleeve and still having 90 lbs to lose it was a definite that it needed to be done. Dr K is the best DS surgeon in so Cal but our Kaiser plan doesn't cover a DS unless proven medically necessary with no other option. Not all Kaiser plans are the same so just have to call member services or talk to your surgeon or primary dr and see what can be done. There is ways to get Kaiser to cover the DS just have to be firm and find a way to convince them if your plan is like mine. Good luck

shannon1891
on 12/31/14 1:18 pm - It Never Rains In Southern, CA

RNY on 07/07/09 with

Thanks for the information. I had previously requested to take the class over again and was told that that was an option. I made that request simply for the support but now that it may get me to my goal, i am even more excited. My concern was that the pouch was either stretched or my anatomosis was blown out. I'm not sure if they consider that a medical necessity, but, I've requested my policy and will see what it says before I proceed with the formal request to switch.

Whit
on 12/30/14 4:50 am

Revision on 12/10/12

Dr. Rabkin in Northern CA. works with Kaiser. I am not sure exactly how that works but you may want to check in with his office. I know of several people who have traveled to No. Cal. for surgery.