Health issues question

JudeS
on 1/31/14 9:17 am - Sulpur, LA

Okay guy's need some info. 

 

Our insurance only cover "gastric bypass". I have some issues that I hope, don't really want the bypass, may be contraindications. 

 

1. I am a long term pain management patient due to several cervical spine surgeries and have to take steroids and NSAIDS at times.

2. I have redundant colon

3. A lot, my gastro's terms, of diverticulosis and have polyps.

4. I have Irritable bowl syndrome. Bouts of constipation and diarrhea. 

 

Thanks

Jude

poet_kelly
on 1/31/14 9:48 am - OH

The NSAIDS would be a problem with gastric bypass.  Steroids would be OK.  I don't know about the other issues.  I assume you are hoping to get your insurance to cover another surgery instead of bypass?  Which one, the sleeve?  I think you need to consult with a bariatric surgeon and maybe also a gastroenterologist.  If you have a couple of doctors saying RNY is contraindicated in your case, I'd think you'd have a good chance of getting VSG approved.

View more of my photos at ObesityHelp.com          Kelly

Please note: I AM NOT A DOCTOR.  If you want medical advice, talk to your doctor.  Whatever I post, there is probably some surgeon or other health care provider somewhere that disagrees with me.  If you want to know what your surgeon thinks, then ask him or her.    Check out my blog.

 

Kate -True Brit
on 1/31/14 10:01 am - UK

With thise issues and those medications, seems to me your doctor may have strong views about the appropriate surgery for you. 

Highest 290, Banded - 248   Lowest 139 (too thin!). Comfort zone 155-165.

Happily banded since May 2006.  Regain of 28lbs 2013-14.  ALL GONE!

But some has returned! Up to 175, argh! Off we go again,

   

AnneGG
on 1/31/14 1:01 pm

Does your insurance have specific wording about what it will or won't cover? Does it allow for any exceptions?

"What the caterpillar calls the end of the world, the master calls the butterfly." Richard Bach

"Support fosters your growth. If you are getting enough of the right support, you will experience a major transformation in yourself. You will discover a sense of empowerment and peace you have never before experienced. You will come to believe you can overcome your challenges and find some joy in this world." Katie Jay

JudeS
on 2/1/14 12:04 am - Sulpur, LA

I am going to see a surgeon next week, I hope.

 

I am looking at the sleeve surgery.

 

My insurance does have specific language, but can be appealed. I am hoping to get enough info to appeal thier decision and was looking to see if anyone here may have had some of these issues before.

 

Thanks for the replies

AnneGG
on 2/1/14 1:29 am

You sound like a strong advocate for yourself- yay!!!

"What the caterpillar calls the end of the world, the master calls the butterfly." Richard Bach

"Support fosters your growth. If you are getting enough of the right support, you will experience a major transformation in yourself. You will discover a sense of empowerment and peace you have never before experienced. You will come to believe you can overcome your challenges and find some joy in this world." Katie Jay

MsBatt
on 2/1/14 1:40 am

I'd say you have sufficient reason that an RNY/gastric bypass would be unsuitable for you. Have your surgeon submit for the procedure you want, using the appropriate code. (In the world of insurance, coding is everything---loose terms like 'gastric bypass' don't mean all that much.) You *may* have no trouble at all getting the surgery you want, but if they refuse---appeal. I think you can win.

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