Question:
approval for a revision

I had open RNY in 2000 by Pacificare or Orgeon. I did not get the surgeon I had chosen to do it. My insurance carrier said no to him but agreed on another surgeon. This man was a surgeon and an oncologist. He had been trained to do open RNY by his office partner. I had a goodly amount of weight loss after surgery and lost about 110 pounds. But, I have since gained almost all of that back. Since the surgery I developed a huge hernia and the pouch has disrupted as well. I went to a physcologist, had a sleep study done and saw a nutritionist, all approved by my insurance company. The insurance company has refused a revison as they deem it not needed and not medically necessary. My BMI is about 58 so I am still obese. The surgeon tried to get my revison approved even though he is no longer doing any of these surgeries any more. He said that he would do my revision if I was approved.    — Charlotte T. (posted on January 21, 2006)

January 21, 2006
Dear Charlotte I was very saddened to read your story. There are many that this has happened to. I am guessing that you didn't have the support and follow-up that is so necessary to make this journey. The key cornerstones are. 1. follow your nutrition to the letter that your doctor ordered, if he didn't you need to get post hast to a support group where the folks there will show you, and 2. exerise to incinerate your stored fat. The operation doesn't do it for you, you do. But when that is done, you should find it easier to remain at goal weight. I have for over 15 years, though not with out having to get rid of some old and very bad habits. And relearn some new healthy ones. It is possible. Go back to your doctor(s) fight and win. Oh and by the way I think maybe a revision is necessary or at least an exploratory to see what has disrupted thereby sabotaging all your work I wish you well Charlotte
   — Lise K.

January 21, 2006
Dear Charlotte, I personally believe you need to consider an attorney to go up against your insurance company. Also, maybe your insurance company would now aprove the original doctor you chose. In the meantime definitely get yourself to a support group and continue with the nutritionist. How sad that insurance companies would rather pay for problems after they occur rather than let people work with their physicians to prevent them. You are in my prayers!!!! Doreen
   — doreena

January 21, 2006
Hello Charlotte, Have you looked into the Band over Bypass Surgery? It is not as drastic as what you are talking about. There aren't a lot of surgeons doing it here in the US, but there are some. My husband had it last year. I have the band since 11/04. If you need info on who may do it contact Inamed the makers of the band approved here in the U.S. or Call Dr. Lee Grossbard's office here in Florida (813) 788-5569, they may be able to recommend someone in your area. Good luck, I will keep you in my prayers. Terri
   — Terri DesVignes-Henderson

January 22, 2006
You say that your pouch was disrupted. If you have a staple line disruption, your stomach is functioning as if you did not have the surgery. Get an endoscope to see if you have a staple line disruption. If you have one, that is medical grounds for a revision.
   — sjbob