DEVESTATED

hey i just came from my surgeons he said i def need a revison..  my pouch is totally stretched and i can eat more than some people that never had the surgery ever.. prob is im 5'7 200 and my bmi is 31.. he said he would do the revison on me im a good candidate but insurance denied it.. i have to have bmi 35 with co morbids.. im at 31 with a list of co morbidities.. now what/???     I DID NOT DO AN APPEAL YET.. IM NOT BEING REALLY AGGRESIVE ABOUT IT BECAUSE IM IN SCHOOL AND I WORK RIGHT NOW SO TAKING OFF WORK IS A PROBLEM  AT THE MOMENT.. HE MADE ME DO THE COTTAGE CHEESE TEST IN HIS OFFICE I ATE 15 OUNCES OF IT WITH NO PROBLEM AT ALL HE WAS LIKE WOW I WAS SUPPOSED TO BE ABLE TO TLERATE MAX 8-9 OUNCES.. HAD UPPER GI MY FOOD DOSENT STAY IN ANY LONGER THAN 5-7 MINS.. EGD SHOWS ENLARGED STOMA AND POUCH.. I ONLY LOST 30 POUNDS SINCE MY SURGERY.. SO I NEED TO FIND A NEW SURGEON BECAUSE I CHANGED INSURANCE MY SURGEON CANT OPERATE ON ME HE IS NOT IN NETWORK AND COSTS AN UPFRONT FEE OF 4.500 WHICH I WILL NOT HAVE ANY TIME SOON.. BUT I DONT KNOW IF ANOTHER SURGEON WILL DO A REVISION FOR ME. MY SURGEON THAT DID MY RNY SAY HE WILL REVISE IT TO EITHER DITAL RNY AND TIGHTEN POUCH OR LAB BAND OVER RNY OR HE SUGGESTED STOMAPHYX BUT THE 3 PEOPLE I KNOW THAT HAD IT DONE WERE ONLY REALLY ACTULLY RESTRICTED THE FIRDT FEW WEEKS THEN BACK TO NORM, WHAT A WASTE OF 10,000.

Wow, I am so sorry to hear this. So, does that mean that your original surgery was done incorrectly?? they left too large of a stomach to begin with?? I hope that you can find a way to get the revision~don't give up!

I would definately be aggressive as far as the surgeon being accountable first of all. If that is even an option. Would they consider this in your appeal ? It makes me angry that you have had to go thru so much already & now insurance to deal with. Maybe I'm incorrect but, I would try all measures. If your first surgery was not done properly. That's not right with such major surgery. Other than that, I thought I "stretched" out my pouch too. I could eat as I did before surgery even & was hungry all of the time. It's been 5 years since my RNY.  Then I did the 5daypouch test & after that have been getting back on track.  NOW I feel my pouch & can only eat small portions again since I'm following the  rules again. I'm not asking myself if it still works. I know it does...stopped gaining & feel myself losing the 50+ or so I put on. Keep your head up sweetie. I wish the best for you. Keep us updated !

Wow...Sorry to hear all that!  What a lousy end of the stick you got!  I hope you can get someone to help you. It shouldn't be like that at all! Good luck getting it all figured out!  I hope you do... Big Hugs!   I have family in Sayreville!  :) 08872! Anita<---Jersey girl transplanted to VA

Sounds like your surgeon is admitting there are problems with what he did. It's hard to confront him,  but I might ask him to help you find a surgeon that will do a revision, since he obviously made some mistakes. You might even think about talking to a malpractice attorney if he won't help you. I don't know if you want to come into Manhattan, but I can really recommend my surgeon at Cornell Medical Center, Alfons Pomp. He does both surgeries, RNY and DS, and he also does revisions. They have a staff of people that is used to negotiating with insurance companies. But, if he's out of network, that won't work. You are a beautiful girl on your profile photos!

I am interested to know about revisions.My Dr says one can't revise as the pouch is too thin...said the stoma stitching doesn't work (interesting to see others say it works only for a few weeks). My DR says only thing is Lapband but I don;t want that plastic thing in my body (except as absolutely last straw if I start to gain wright). So I am interested in all points of view about revisions and anywhere I can read things about this... thanks for your kind help, Kay

I agree with Scott about the appeal, but it gets complicated with the insurance switching. Can you meet with someone in human resources at your job to discuss filing an appeal? I don't know if you've been public at work about the WLS, but telling HR if you tell them to keep it in confidence SHOULD be okay. I hope you win, but I wouldn't let your surgeon back in there. You need to find someone new. This is what I'd do 1. speak to HR about how to file an appeal 2. speak to your surgeon about his help in finding an in-network surgeon who can fix what he screwed up (in a nice way at first, in a less nice way, if he refuses) 3. have your old surgeon send your records to an experienced surgeon (like Dr. Pomp) who will judge what should/can be done to fix it and whether it will be successful. Even if it costs $200, it's your body and it's the rest of your life with what surgery is done next. 4. you are absolutely right about a lap band over an rny and the procedure that is supposed to fix the rny. I wouldn't let anyone do either on me. 5. if all of the above fails, call a lawyer to either deal with the insurance company or the original surgeon. Good luck to you. Keep us posted about what happens! Nancy

i want to truly truly from the bottom of my heart thank you all for being so suportive!! im going to start the apeal process and hope to do the revison in the summer i can take a week off work and school.. i will keep u all posted incase this ever happends. nicole

I'd say file an appeal.....you don't need WLS...you need a revision based on a mechanical break down.  This should be the basis for your appeal...not your BMI or the need for a NEW WLS.. Scott