SOoooooooo! frustrated with the insurance and doctor's office run around for RNY revision!
I started the process of trying to get an RNY revision over six months ago. I had a consultation (another 2+ hour waste of my time) followed by an upper GI that they required, because I had my surgery 12 years ago and the consultation doctor kept saying "wow, there really is no reason you should have gained the weight back, I don't understand." Yeah, me either, silly! "This type of surgery usually really works!" he said. Yeah! It did! For TEN YEARS!
Ok, so I paid for the upper GI. Then I waited a few months. I called the "surgical medical center" (that is really just a store front where they recruit desperate people) a few times to see if the doctors had seen the results yet. "Nope, not yet." I kept telling them that I wanted to get the procedure done before the end of the year (I started this process in June/July?!) because of copayment issues.
I finally gave up in December. I settled for being this fat for the rest of my life. Maybe I was just supposed to be this big. Still no signs of hypertension, diabetes, thyroid issues, etc. I am from eastern European heritage, and women in my family are just naturally big boned!
However. I'm in nursing school...and that complicates things. I'm on my feet constantly, and I HURT. It hurts to move, it hurts to walk, and basically, I'm not exactly the shining example of health.
So the orignal strip-mall-wanna-be medical clinic calls me back last week and says, "we are referring you out to our doctor that specializes in revisions." Oh gee, REALLY? I told you FROM THE BEGINNING that I needed a revision.
They referred me to a doctor in Beverly Hills, which is almost three hours away from me. I made a last minute call to my insurance company tonight, and they informed me that I will need to have the surgery at a "Bariatric Center of Medical Excellence." Well, isn't that special? How do I find a doctor that does the procedures at these centers, that are (relatively) close?
My choices are: Huntingon Hospital/Pasadena, Keck USC, Marina Del Ray Hospital, Methodist Hospital of Sacramento, St John's Regional Medical Center in Oxnard, UC Irvine, Chapman Medical Center/Oange, Orange Coast Memorial Medical Cntr/Fountain Valley or Parkview Community Hospital/Riverside.
My out of pocket expenses will probably be $3,000-$4,000 which is okay, but much more than that, and it won't be happening.
Just venting. I'm not looking for answers. I swear, my first surgery was NOT this complicated at all. I went from zero to surgery in less than three months. Got a phone call on Monday asking if I wanted my surgery five days later. Ughhhh!
By the way, my insurance is CalPers Choice Anthem Blue Cross, in case anyone can help with that headache.
Thanks for listening,
Frustrated in the Desert
Original Weight: 263 - RNY June 2003 - Loss of 125 LBS/February 2014 - Lowest weight: 135 
Current Weight: 246
Update: I contacted Huntington Memorial Hospital's referral service, and got the name of Dr. Pehrsson, and double checked that he is a provider through my PPO. He was, and that was great. When I called his office today, I was TOTALLY blown off by his staff after I explained the situation, that I had RNY surgery 12 years ago, kept the weight off for ten years, and have since regained and am looking to have a revision. "Oh, so your PCP didn't refer you?" "Do you have documentation of diet, exercise and blah blah blah for the last two years?" I explained that ever since I started regaining the weight, I have been getting my T3 and T4 levels checked to check for thyroid issues, and been watching A1C1 for possible diabetes, all of which have come back normal. "Oh, sorry, we can't do your surgery."
Um...ok, thanks?
Through Delano Medical Regional Center, I found Dr. Keshishian, and contacted his office this morning. SO much more helpful. Holy smokes! I submitted all my insurance information and hope to hear from them in the next few days.
Dr. K is an in-network provider for me, and through my insurance it will be around $6000. I'm seriously thinking of going to Mexico now, for $15,000, and SO much less run around.
For other out of network providers that I saw (West Medical) they would never answer my question about my out of pocket cost. All they said was "we will submit a bill to your insurance three times, after that, we can't legally ask them anymore." Uhhh, okay? Then what? Then I'm left with a $30,000 bill??
I looked on his website and his fee is out of network (meaning they do not accept ins. for his portion) and his fee is $15,000 upfront. They will bill the hospital, etc. I cannot afford this and have been searching for a doctor who does the conversion from RNY to DS and accepts ins. ( I have BC/BS out of PA and Tricare). No such luck! I think it is crazy that non of the "vetted surgeons" accept insurance! I don't know what to do, still researching. Good luck to you, keep us posted on what you decide to do.
Thanks, Doug. Watching you on your journey with him helps a lot. I called and asked to be put on a list in case anyone cancels their consult with him. Waiting until March 10th feels like an eternity!
I am starting to really start thinking about recovery time. For my RNY, I had surgery on Friday, was home from the hospital on Sunday and life was normal for me on Monday. Never looked back. No complications or anything.
I realize I am older this time (39), but other than the extra weight I carry, I am still pretty healthy. I'm hoping recovery goes smoothly this time, too. I was reading in Dr. K's patient handbook last night that most people take 4-6 weeks off work, and I was blown away. I can't imagine taking that much time off, and frankly, I can't. I also read that most of the revision to DS patients stay at the hospital three nights. I'm just really hoping he does surgeries on Fridays!!! Does anybody know?
Thanks!
