I am converting from sleeve to RNY.

Sleeve was paid by private insurance.

Medicare will not pay for revision if they did the primary surgery.I am approved by Medicare A and B. I have United Health

Care plan F. They have paid for everything at this point.

My best to you.

I wanted to make you aware of what I'm experiencing now. It may or may not help you in your decision. I had the Gastric Sleeve in Mexico over 12 years ago. My experience was wonderful, lost over 100 lbs and I've kept it off. Approximately, 2 years ago, I started throwing up undigested food, every time I eat.(A lot like the way you describe your band experience).

My doctor in the states found that I had a large para esophageal hernia and they were able to repair it and it was suppose to take care of my problem. My surgeon said my sleeve looked fine. It was a little larger than they make them now, but consistent to how large they were left 10-12 years ago.

The reflux did not go away and therefore my doctor thinks I need to be converted to a RNY. Now, I have a huge problem. When my surgeon sent in the prior authorization for the conversion, it sent off red flags. My insurance is starting to recoup monies paid because they say it's due to complications to my weight loss surgery. My insurance covers weight loss surgery, but you have to follow their guidelines to get it paid. They are telling me that because I did not go through getting it approved with the insurance carrier that I had at the time of surgery, (which was not BCBS, but they were just as strict about weight loss surgery, thus why I went to Mexico) they will not cover any of the procedures that I have had done due to complications, nor will they cover the RNY.

I will be eligible for Medicare in December and at that time I plan to have the procedure. I know that there are US doctors that include complication insurance in their cost. I strongly recommend you check into that. Right now, I'm looking at approximately $150-$200,000 out of pocket for procedures and testing I have had done. I am hiring an attorney to fight BCBS, but I don't know how that will go.

I also want to tell you that even though, I'm going through all of this grief and I don't have the $150-200,000 that I will be responsible for, I don't regret my sleeve. I think it saved my life. I had a stroke in 2015 and if I had still had that extra 100 lbs on me, I probably would not be alive or I would have had serious complications. As it is, I'm very fortunate that I did not have lasting side effects from the stroke. I am on blood thinners for the rest of my life, but I am alive and I think the sleeve is the reason I am. Just my thoughts.

I am not trying to scare you, but wanted you to know all the possibilities up front.

Good luck!

I am 12 years post sleeve. I lost over 100 lbs and I haven't had the weight gain. However, recently I started having severe reflux and I had a large para esophageal hernia that pushed my stomach into my chest cavity.

My surgeon was able to repair the hernia, reconstruct my diaphragm and pull my my esophagus and stomach back into place. We thought everything was great, but the reflux did not go away. I basically throw up after each meal.

I had my sleeve in Mexico and paid out of pocket for it. My insurance now that I've only had for 5 years said because I didn't go through the insurance that I had 12 years ago they won't cover. They are in the process of recouping money they have paid for all my procedures. So, in addition to having the reflux, I now have the added stress from the insurance company.

My insurance changes to Medicare in December and they should cover most of the RNY. I'm going to deal with the reflux until that time and I'm searching for an attorney to fight my insurance company.

If you decide to have the RNY, I would love to see how your results are. I am worried that if I do have the RNY that it may not fix the problem. My doctor at the Mayo Clinic assures me that the problem will be resolved.

Good luck on your journey!

I have not heard of Lindstrom. Where are they located and how can I reach out to them? Do you have any knowledge of how Medicare would handle? If my insurance is not going to pay, I'm going to have to wait until my Medicare becomes active in December. It's a daily struggle, but I can't afford to pay more out of pocket. As it is now, if they take back all the money they have paid for the hernia repair, test, etc. I'm probably over $200,000 in debt and that's more than I can afford before getting my problem resolved.

I had a self pay gastric sleeve approximately 12 years ago in Mexico. I lost approx 100 lbs and I have kept it off. In the last couple of years I started throwing up a good bit. After many test my American physician found that I had a large para esophageal hernia that was pushing a 1/3 of my stomach into my chest cavity. I had the hernia and my diaphragm needed repair. My doctor said my sleeve looked good. He said it was larger than what they make them today, but looked about the size the doctors did the 12 years ago. After the hernia surgery, I continued throwing up. My surgeon now says that the only way he can correct my problem is to convert me to an RNY. My BCBS is not wanting to cover. Even though I was not insured with them 12 years ago they said I didn't go through an insurance company to get approval for the original sleeve. They are also pending my follow up visits from the hernia repair and requesting medical records. How can they do that? Is that legal? Also, in December I will be eligible for Medicare. I was told that traditional Medicare would cover my revision, but if I went with a Medicare Advantage plan they may not. The Medicare Advantage Plan would be through my husband's retirement benefits. Has anyone had this problem before? If so, any suggestions on how I can get BCBS to cover this. Any recommendations on which Medicare plan I should consider?