Insurance Approved my surgery... I think there is a mistake
on 5/3/17 1:47 pm, edited 5/3/17 1:47 pm - Orlando, FL
For some odd reason my insurance approved my revision surgery. I had RNY 10 years ago. Federal BCBS requires a 3 months diet, psych clearance, nutritional meetings and all that. I have not done any of that but they still approved. I have no idea what the doctor put.
How did this happen?
Who cares? As long as the approval is in writing, just take the next steps. If you don't have an approval in writing, walk softly.
6'3" tall, male.
Highest weight was 475. RNY on 08/21/12. Current weight: 198.
M1 -24; M2 -21; M3 -19; M4 -21; M5 -13; M6 -21; M7 -10; M8 -16; M9 -10; M10 -8; M11 -6; M12 -5.
on 5/3/17 3:35 pm - Orlando, FL
MY BMI is 42. I am revising to RNY (they are making my pouch smaller). The surgery is actually the one CPT 43860.
But I have decided to convert to DS.
MY BMI is 42. I am revising to RNY (they are making my pouch smaller). The surgery is actually the one CPT 43860.
But I have decided to convert to DS.
The big question would be what exactly did your insurance approve you for?
Did they approve you for the revision of the RNY or did they approve you for the DS? If it is for the revision of the RNY then your doctor will have to resubmit to get approval for the DS.
Dr. Sanchez Lapband 9/12/2003
hw305/revision w280/cw197/gw150
Revision from Lap Band to Bypass on 2/4/2015 by Dr. Pohl
on 5/4/17 4:20 am - Orlando, FL
They approved a RNY to RNY revision, pretty much a surgery that will make my pouch smaller. It is called Revision of gastrojejunal anastomosis.
I got my labs after they submitted all the paperwork and discovered that my glucose is high. I don't think this surgery they just approved will do the job. This is why I don't want to do it but switch to a DS but my surgeon does not do DS. I am going with one of the vetted ones.
I understand that they have to submit the insurance paperwork again but I'm wondering if they'll waive the 3 months diet, the psychological clearance, etc. Timing and of course money is an issue for me. My insurance does cover the DS by the way.
Revision of gastrojejunal anastomosis will not actually make your pouch smaller.
Don't be in a hurry. Take a breath, step back, and do a LOT of research.
Revision to DS from RNY is a huge, huge deal. There are maybe 5 or 6 surgeons in North America who have experience doing it. Ask on the DS board for the list they keep. You'd be nuts to have anyone else even attempt it. It's a very serious, life threatening surgery.
Many doctors say the will revise you to a DS, but ibstead give you a distal RNY. You won't lose weight, and you'll have lifelong complications. This happens so often that there's a saying -- "Instead of the duodenal switch, you got the bait and switch."
Go slow. Be smart.
6'3" tall, male.
Highest weight was 475. RNY on 08/21/12. Current weight: 198.
M1 -24; M2 -21; M3 -19; M4 -21; M5 -13; M6 -21; M7 -10; M8 -16; M9 -10; M10 -8; M11 -6; M12 -5.
on 5/4/17 5:01 am - Orlando, FL
Hi Grimm. I am using one of those 5 or 6 surgeons in North America.
Then, what is a revision of gastrojejunal anastomosis? I gotta check that one.
It's a tightening (or attempt to tighten) the stoma. There are various terms, like the Rose, Appollo, or stomaphyx. None of them have even a fair success rate, and almost all of the weight lost is from the pre and post op liquid diets.
6'3" tall, male.
Highest weight was 475. RNY on 08/21/12. Current weight: 198.
M1 -24; M2 -21; M3 -19; M4 -21; M5 -13; M6 -21; M7 -10; M8 -16; M9 -10; M10 -8; M11 -6; M12 -5.
on 5/4/17 5:53 am - Orlando, FL
I know. That's what I've read. This is why I am going to travel to get the DS with an experienced surgeon.
