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Thank you for the response! I've decided to go with traditional Medicare. My surgeon is at the Mayo Clinic. The Clinic gave me the procedure and DX codes. I called Medicare and they told me the same thing no PA is required and if the doctor submits with documentation of medical necessity there shouldn't be any problem. They even told me what my out of pocket would be.
My surgeon's letter to my current insurance states that due to the spontaneous reflux, I am not getting the nutrients to sustain life. So, I think I'm covered there.
I think I'm just very nervous about having the procedure and I'm a worrier about money too. Bad habits I know. I'm waiting on the surgeon to schedule my date. I'm hoping to have it early December. My surgeon is out of the office until late fall.
Thank you!
on 9/11/19 7:53 am
There are lots of different medicare plans and we can't tell you if the procedure is covered under your specific setup. Call them (1-800-MEDICARE) and they can help talk about your particular coverage.
Several people on OH have had revisions for GERD while at a normal BMI and it hasn't been a problem to maintain their current weight.

Sparklekitty / Julie / Nerdy Little Secret (#42)
Roller derby - cycling - triathlon
VSG 2013, RNY conversion 2019 due to GERD. Trendweight here!
My surgeon has told that due to spontaneous gerd I need to be revised to an RNY. My BMI is normal and really do not want to lose any more. Has anyone had problems like this and Medicare pay for the revision?
My lifelong severe GERD ( due to a birth defect of a huge hiatal hernia ) was totally resolved after RNY .
I am sure another revision is possible, but please do more research before considering it. Multiple surgeries can be very dangerous for our bodies. You could end up with lifelong issues and that could lead to an early death (this happened to a friend of mine after she revised her RNY to DS).
My hunger came back with a vengeance, too (I am up 25 pounds). I attribute it to poor food choices and not taking care of my mental health. I see a counselor and am going to join WW.
Laura in Texas
53 years old; 5'7" tall; HW: 339 (BMI=53); GW: 140 CW: 170 (BMI=27)
RNY: 09-17-08 Dr. Garth Davis
brachioplasty: 12-18-09 Dr. Wainwright; lbl/bl: 06-28-11 Dr. LoMonaco
"May your choices reflect your hopes and not your fears."
on 9/6/19 7:52 am
First step is to check in with your surgeon to take a look at the state of your pouch. If there's nothing physically wrong with it, you're likely much better working with behavior modification to lose the weight you've regained; many people here on OH have lost weight many years after surgery by going back to basics (weighing, measuring, and logging food).
You may also want to work with a therapist to help you address your eating patterns and the emotional side of weight loss.

Sparklekitty / Julie / Nerdy Little Secret (#42)
Roller derby - cycling - triathlon
VSG 2013, RNY conversion 2019 due to GERD. Trendweight here!
- I have bcbs of Illinois and was denied 2 times they didn't consider GERD as a medical criteria so i now am going back for a second sleep study and going to try again with sleep apnea, high blood pressure and knee and feet issues that have been limiting me due to the weight. Hopefully they will approve me tis time. Also I'm going back to my surgeon and getting back on track.

Elia Maria Saenz
See your bariatric surgeon and requst them to take a look at you and advise you what to do they are the professionals. My friend had an injection in her pouch and it helped her lose some hope the very best for you. I myself have been trying to get revised from vsg to rny I've been denied 2 times but this time i know the criteria so I'm going to try again.

Elia Maria Saenz
on 9/4/19 9:24 am
I recently converted from VSG to RNY due to GERD, about a month ago.
- I was off work for 2 weeks, but ended up calling out 3 days in my first week back because I was exhausted and feeling generally miserable. The pain was only bad for the first week, I took a little Tylenol during week 2 but it was much better by that point.
- I was cleared to do walking, nothing strenuous, right as soon as I got home, though honestly I didn't have the energy to do much. 20 minutes on the exercise bike and I was ready to pass out. At 4 weeks out I was cleared for "everything," I did a 45 minute bike ride this weekend and it was kind of miserable but i pulled it off.
- Can't speak to this as I'm currently working to lose weight (regained some after VSG). However, you should be able to prevent yourself from losing too much weight as long as you keep your calories at the maintenance level-- totally possible after RNY.
- My GERD is completely resolved. I'm still on Prilosec for 6 months as a precaution, but I haven't had any acid trouble since the day I cam home from the hospital.
- Your eating habits will honestly not be that much more different from after VSG, with the exception of the (possible) exclusion of refined sugar. So you can definitely do a fancy meal.
- I don't know how to define "normal," but I'm not dealing with constipation or diaherrea right now. Stool quality is a little different because of the malabsorption, but it hasn't caused any trouble.
- Alcohol is generally best avoided after ANY surgery. Transfer addiction is a dangerous possibility, plus the alcohol will hit you harder after having your digestive system altered. The empty calories don't help, either.

Sparklekitty / Julie / Nerdy Little Secret (#42)
Roller derby - cycling - triathlon
VSG 2013, RNY conversion 2019 due to GERD. Trendweight here!