Revision surgery 14 year later

Unfortunately the only people who can tell you whether or not a revision may be covered is your insurance company. I'd start there if you can't afford to self pay. 

Coverage varies as it's dictated by the entity sponsoring the insurance plan. The best way I can explain is, I worked for one of the largest health insurance companies at the time of my rny, in medical review, which ironically we reviewed bariatric surgery. 

While a lot of our clients had patients with set criteria, our own employees at the time, it was clear cut exclusion in 2001, at the time of my rny. At the time I had gotten a lot of misinformation because I live in MN and in 2001 (it changed in 2003) that if a health insurance company was headquartered in MN, they had have a different company administering the health insurance plan. 

Clarifying, I worked for UHG in Minneapolis, had Medica in 2001. Bariatric surgery was an exclusion for all UHG employees in 2001. Unfortunately when I called the 1st 2 times, I was told it was covered because it was covered with review and set criteria in 2000 and again in 2002. Because I called 3 times, and was told that last time that it was an exclusion, I had to appeal and I lost. 

While dealing with health insurance companies is not as confusing as my scenario, it is good to call them and if you have coverage manual for 2017 for your particular plan, to read it. 

I know this didn't help much. The only thing that can also be confusing in your situation, is that most bariatric surgeons's offices will not make an appointment without verifying coverage for the office visit. But you can't assume just because the office visit went through and they scheduled the diagnostic for the egd, that it's covered, to protect yourself from surprise medical bills, you might want to ask if that coverage is for follow up versus the potential of you being able to have a revision. 

Not saying this to be a pessimist. Saying you don't want surprise bills just starting out for all of this, if a revision is going to be an exclusion.

I hope this works out the way you want it to. Keep us posted... 

Thanks for the information. I worked as a surgical coordinator for an orthopedic surgeon and know that for each CPT code there are many loops. I had my endoscopy done this morning, and the doctor found dilation of the anastomosis, I have to follow up with him in the office to discuss my options because of the abnormal lab results. He mentioned briefly going in and reducing the size of the anastomosis but all the information I've found would really apply to me. The endoscopic procedures are for patients who have gained 30-50lbs. I have gained back 100% of the weight and am afraid that the endoscopic procedures are not what I need. I had discussed with my original surgeon placing a band over bypass but unfortunately she does not par with my insurance and I cannot afford to pay out of pocket. My current doctor had stated band over bypass has a lot of risks. I will now wait patiently and see what he will recommend. 

Also the dilation of the anastomosis is considered technical failure, what is your input on that? 

I'm sorry I haven't gotten back to you in a timely manner, I'm on here sproadically. 

I only know one person where Band Over Bypass was done for a preventive measure for a rny peep who had like kept off already 90% of their excess weight and they went to Mexico for that. 

From what I've heard from others who know peeps who did BOB it didn't work. It caused the same issues that people who converted from vbg and agb revised to rny or ds. 

For most people with revisions, usually revising from rny to DS is their best shot, from what I've seen and others who know more about revisions than I do. I have had friends personally revise, who are our generation of wls peeps, with mixed results. 

That doesn't mean another way won't work for you, depending on what your coverage is. 

I think EGD is a good place to start out from a diagnostic point of view, but I agree that it probably won't help other than to pinpoint what you already know. But it's good that they are being thorough. 

I hope others do chime in, especially people similar *****vised from rny to DS, after a long period of time. 

I also hope things work out the way you want them to. 

Keep me/us posted... Positive support in this, wherever you are in the process can only help, not just you, but others who may lurk realizing that they are due positive support and have suffered in silence, you should be very proud of yourself for speaking up. And know you are not alone in your struggle... 

I have a band - WORST thing ever. I would never suggest it.

Thanks for your response. I saw my doctor this past Tuesday he is planning to revise laparoscopically and reducing the stoma.I am seeing a dietitian on Monday and then the office will request authorization from my insurance.

The way the surgeon explained everything  it seems that its a simple procedure. 

Hi, please keep me posted on your progress. I had rny February 2002 and lost 100 lbs but have since regained all the weight back and I'm also seeing my gastric bypass doc again to see about a revision as well. My appointment is on 2/27. As a result of my weight gain was diagnosed with esophogitis and gerd. The acid reflux is terrible and hard to deal with. I'm on prescription poi and liquid carafate but it is far from controlled. I would like to know how you are doing with your progress. I have Aetna insurance so I'm praying I can get approved for a revision but I too am scared. Best of luck to You!

dDana Handy

Thank you. I just scheduled my procedure today, it is going to be on March 17,2017 God willing. I will meet with the doctor again on the 7th of March to sign consents and get m post operative instructions. He will be doing a laproscopic procedure to reduce the stoma, and possible reduce the pouch.

I've met with a dietitian and she was of much help. I will also be seeing her on March 13, 2017 and plan on continuing to see her post operative. I will share details as I go along. Hope your appointment goes well. Keep me posted.