I need help and quick!! I am so scared!!

Hi guys, It's been a long time since I had a computer to get online. I had my WLS back in 2002 and it went great. I lost from 288 to 163 in no time. BUT, about a year ago I started putting on some weight here and there I I noticed that I felt hungry more often and it took more to make me feel full.Anyway over the pasr year I have seen my surgeon 6 times. I have tried to explain to him that I felt different and that something had changed. Each time he would reasure me that I was fine and that I looked great and it was expected that I would gain some of the weight back as my body adjusted. So, I let it go. Well about a month or 2 ago (not sure anymore, I can't keep up) I got on the scale and I have gained back up to 205. I decided that I would call him again. This time I told him that I knew something was wtrong and if he didn't want to bekleive me and check into it, then he needed to refer me to another doctor that would. He then set up for me to have an upper GI and a small bowel done. The next day after the test he called me and wanted me to come in. I went in and he said that my staple line was descentagrating(???spelling) and that the food is seeping into my old stomach. He also said that this usually only happens when an infection is present. He said I need to have a revision. The way I understand by the picture he drawed me is the first time he place staples across the bottom of my pouch and then repositioned my small bowel into the pouch. This time he says he need to cut and suture where he stapled the last time. Well first of all before the first surgery he told my sister and I that he would cut and suture the pouch then. He has told me that this time it would be wors4 because of the scare tissue. That is still not the problem. So here goes. I have a different insurance now than I had when I had the WLS in 2002. It is now Blue Cross and they have denied the surgery. They say that because of the policy that my husband company decided on, that gastric surgery is not covered. This is something that I must have done and I sure don't have the money to pay for it. Actually I have been trying for 2 year to save for PS and just haven't been able to. Something always happens. Car blows up, daughter and kids move it, you understand what I mean. They say I can appeal this, but I don't know what to say or where to start. This surgery is not WLS it is a repair and I can't live with food going into my old stomach with my small bowel moved up to my pouch. The insurance company is sending me an appeal form and they say they have 30 days to make a dission about the appeal. My surgery is already scheduled for September 12th, so what I need Is your help in convincing the insurance company to pay for this repair. I love my new self and I just want to be that happy again. Poodl8dy, Ronda

Hi Ronda, I fell like I just read my own story. My surgery was also 2002. I've gained 50 pounds back. I just won my appeal. Send me an email and I can write back and attach a copy of my appeal. Maybe it will help you. I have Horizon Blue Cross, NJ Plus. They denied as they felt not medically necessary. I had to get Dr. notes from every Dr. I had seen the last 3 years. I got all test results. I have co-morb medical problems so maybe that helped. It is a long fight but you have to keep going. I put alot of time and effort into the appeal. My surgery is scheduled for October. I don't have the staple decinigration (sp?). My stoma and pouch are stretched. Good luck. Kathy ([email protected])