Question:
Has anyone had luck appealing an insurances denial for a revision?
I had an open rny in December 2001. I lost at a slow rate and have started gaining the last 6 months. (aout 30 pounds) After a recent scope my surgeon says my pouch and stoma have stretched to 4 times the desired size. He indicated that it was probably not due to overeating but to the frequent vomiting I had the first three months. He feels like the stoma was too small initially and the vomiting caused it and the pouch to stretch. (Of course he did not share that with me when I told him of my frequent vomiting when I went for my check ups) My surgeon feels like I am an excellent candidate for a revision but my insurance denied it. If you have suggestions on what I should do or write in my appeal any input would be greatly appreciated. I am very depressed about the whole situation and feel like I have yet again failed at a weight loss attempt. Thanks in advance for your positive and helpful responses. Diane — Diane W. (posted on August 11, 2003)
August 11, 2003
Diane...I wish I could help you. I haven't even been approved for the
surgery yet, but I wanted you to know that I can understand your
dissappointment. I will keep you in my prayers. It seems the doctor
should offer to fight for you since it may have been partly his fault for
not making the pouch right in the beginning. Don't mean to be critical,
but just an opinion. I truly hope someone has some answers for you. At
any rate, continue pressing on and don't let it cause you depression.
Determine that you will find a way through this and again get that extra wt
off! Good luck and God bless. Barbara
— Barbara G.
August 11, 2003
I'm just getting started with this website and so far it seems pretty good.
I had a RNY in 98 and have gained back more than 1/2 of what I lost. Now
that I'm hearing about all the pre-and post surgery instruction and support
groups, I'm feeling a bit jipped like I lost and now have pudged out again.
What makes one a candidate for revision?
— Wendy G.
April 15, 2004
I had a revision June 03 due to ulcer which kept causing me to vomit.
After revision, I started to gain rapidly. Spoke to my surgeon and he said
he would not do a band on my pouch as he does not beleive in the band, but
I could consider DS, but my BMI is low, I just need to diet and exercise.
I had a scope by a doc that he works with, and that doc confirmed my
suspisions that my stoma was wide open. Of course, when I BEGGED literally
for my surgeon to fix it, he sent me a letter telling me that my stoma was
made to standards and it was not too large, thus contridicting the results
of the endoscopy. He refused to do anything. I found a doc in Oklahoma
that would help. He submitted a very weak letter to my insurance company,
and it was denied. I think it should have been addresses as repair.
Anyway, I have decided to have a band placed on the pouch down in Mexico.
My surgery date is the 17th. The doctor I chose is great, very responsive
and very knowledgeable. Cost is $7200 not including travel expenses. His
website is drungson.com, he always responds to my emails. I spoke to many
docs and he proved to be the most sincere and informative one by far. He
is in Hermosillo. Of course I am upset that my surgeon here would not
help. as I know that if he asked, my medical group would have approved it.
In the interim, I am speaking to a few attorneys.
I wish you the best. By the way, do you find that you are always hungry,
that you never feel full.
— Cheryl C.
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