X Post - Just Denied Revision
I just received a call from my surgeon's office stating that my surgery is denied because BC/BS does not approve "two stage procedures." My VSG was my one shot. The insurance handler at the office wants me to give my surgeon permission to appeal on my behalf but says it "doesn't look good" based on their reasoning.
I'm just devastated.
I am 11 1/2 years out from a RNY in that failed from day 2. Huge stoma, large pouch and very short bypass. I was in the Restore trial in 2007 but it was cancelled and replaced by the overstich years later. The trial put a hole and air was on the wrong side of my diaphragm. It didn't fix anything. I have a tube equal size from my esophagus through my "pouch" through my stoma to my intestines. Nothing stops food from my mouth to my intestines. I have never felt like I have swallowed food. Even 2 days post op in the hospital when I had a protein drink and 3 oz. of purred food (meat, potatoes and carrots). I was surprised that I didn't feel anything in my pouch. This really complicates my blood sugars (I am an insulin dependent diabetic). I have applied for many revisions over the years but insurance won't cover a revision no matter what. March 2007 someone on OH suggested I see a lawyer, but I thought that was greedy. I have health insurance to fix surgical errors...I thought.
All I can say is count calories, expect to always be hungry and empty, space meals and snacks, eat healthy food, get all junk out of your house and raise you goal weight so that you can have an attainable goal.
I will never be "normal" weight but I don't have to be "obese" either. I really wish you well and do the best you can with what you have been given. Perhaps just aiming for what you need to weigh to have your knee replaced. take care, Tri
I'm so sorry you were denied. That's heartbreaking. Why would your revision be a 2-stage procedure? Normally that only happens if you're going from an rny to a DS...and most will still do that as one procedure.
the best advice I can give is to give yourself a moment to tell your disappointment and then decide if you want to fight.
a doctors office rarely wins an appeal. It will take you getting in writing the policy they are using to deny you and in writing their rationale for denying you.
I e looked at a lot of bcbs wls policies and have never seen language around a 2-stage procedure.
if need be, you may need to find another surgeon who will do your revision all at once.
good luck! I hope you find a way to get approved.
I just had my lap band taken out 2 weeks and have the sleeve. I feel like 15 years younger. I am in Canada across from Detroit. I researched so many doctors yeh even Mexico and picked Dr. Mark Pleatman in Michigan yeh I had to pay out of my pocket. In my orientation nutrition ect I had people from Chicago, Indiana, Ohio and Las Vegas. This doctor does 4-6 a week of sleeves, he also teaches doctors on this procedure.
Research Dr. Mark Pleatman 248-334-5444...www.drpleatman.com
Believe me he will help you.
best of luck Mike
