Long Road For Nothing?

So, I was just told by my surgeon today that I have lesions on my bowels. This means that I may not be able to have RNY. I am really getting stressed out about this and I don't know what to do! I am going to have a upper GI on Monday and I have to wait to have another colonoscopy and endoscope. The waiting list for the doctor to do this is MONTHS! My surgeon is trying to get me in sooner! Man, I am sooo frustrated! My surgeon says that if I cannot have RNY then she will do the sleeve BUT my insurance doesn't cover the sleeve! I know that I will not be sucessful with the lap band (my only other option).

Sounds like you  might need to appeal your insurance company for the sleeve.  Take this one step at a time.  First the testing needed.......  Do not give up at this point.  Attitude will get you far.  Look for the best in the situation.  Wish I could give you a hug in person.  Virtual hugs coming you way.

I have an appointment for Monday for an Upper GI so HOPEFULLY I will find something out then! I am definately not giving up! I am going to see if the surgeon will DEFINATELY petition the insurance company for the sleeve if RNY is not an option!

 Hi Jeanine,

I hope you don't  have to resort to an appeal, but in case you do you may want to do a few things to prepare.  1) get you health plan summary of benefits, the big book that outlines what is and is not covered. It can help you understand the process timing and stuff like that. I used mine to determine how I would qualify for surgery.  2) call your insurance plan and find out if you can do a predetermination of benefits (I believe that is the term) to find out if they cover the sleeve or in your case may make an exception due to medical reasons.  Ask the insurance what steps you can take to ask for an exception. 

I hope this may help you to wade through everything. You may want to prepare your letter and send that in with your dr's information so they know you mean business. It is worth a shot, but educating yourself can make sure you feel more in control of one aspect of this whole process.

Lourdes

Hmmmm is there any kind of med available they can start you on to heal the lesions? You poor gal.. is this not your second round with going for insurance approval? Wasn't there a different insurance company about a year ago or something that denied you>? I may be recalling wrong, but seem to remember something...

ANYHOW I will pray that all will work out for you to have this done either rny or sleeve, and please keep us posted! So sorry you have to go through this wait and wonder time.