approved by blue cross for revision Cant find surgent in ca

Im approve by blu cross of california for revision surgery I had in 2001 (RNY)in ohio.Frist surgent that I was refered to would touch it. The next two I was refered to Did,t do revisions.After I fax sent papersfrom ohio and here.Now theyBlue cross said I can pick my own in or out of network?

Hi,

I'm dealing with that myself at the moment all though I just started the process.  I'm looking to revise to a DS possibly but must use a Bariatric COE hospital.  There are a couple in Riverside, one in Orange and one in Pasadena, but I can't find a doctor who can do the DS or stomaphyx that I've been thinking of.  I sent an email to Blue Cross just yesterday to try to get clarification and some doctor suggestions.  If and when I hear back from them I'll let you know.  I'm giving them until tomorrow and then I'll call them.  If Blue Cross is telling you that you can now go out of network and don't have to use a COE hospital then Dr. Ara Kashishian of Central Valley Bariatrics in Glendale does them.  His phone number is 800-816-6647.

Let me know how it goes for you and how you got Blue Cross to let you go out of network.  Thanks.
Stephanie

Stephanie,
Have you looked into the ROSE procedure vs the stomaphyx? 

Hi Darlene,

I've never heard of the ROSE procedure.The problem I'm having right now is that Blue Cross requires the use of a COE hospital....Center of Excellance.  They do not list bariatric surgeons by specialty, but do list hospitals.  When I try to find bariatric doctors associated with the hospitals in San Bernardino, Riverside, Orange and LA County none of them do DS or Stomaphyx.  As I've never heard of the ROSE procedure, I imagine it's the same situation as that.

Part of why I thought about having a revision at this point is that with all my other medical issues this year, I've reached my out of pocket maximum so this would be the year to do EVERYTHING I want done as it won't cost me anything.  I have a request into BC for more guidance on the issue and hopefully I'll hear from them by tomorrow or early next week.  In the meantime, what is the ROSE procedure?

Stephanie

www.palmyrasurgical.com/weight-loss-surgery-georgia/rose-pro cedure.html
www.gulfcoastbariatrics.com/gastric-bypass-surgery-bonita-sp rings-florida/rose-procedure-incisionless-surgery.html

It is similiar to the stomaphyx......it's a restorative obesity surgery endoscopic
It is also incisionless

Thanks Darlene, I'll definitely check it out.

Steph

Cedars Sinai is a bariatric COE. You might contact their program and see if they can recommend a surgeon for a revision.

I do know my doc -- Philippe Quilici -- does some revisions, but I'm not sure which.  I know someone who he banded over her failed RNY (it failed because she got a leak from her pouch into her old stomach). 

Good luck!

Cedars Sinai didn't even come up when I did a search on Blue Cross website.  I'm probably just going to have to call the hospitals around here and find out who their bariatric surgeons are then call each one to see if any do a revision to a DS or do the stomaphyx.  I was told previously by a bariatric surgeon that he would never band over an RNY.  Not sure exactly why, but that's what he said.

I'll just keep on looking or I'll try to see if I can get my pouch back working.  To be honest, I'm never full.  I just feel like the food, no matter what, goes right through my pouch.  Other RNYer's I've talked to who are out 5 years and more like I am are expressing the same thing.  Now I'm not saying this is going to happen to everyone, because it certainly doesn't.  But from what my researching is telling me it's a common problem for alot of long time RNYers.

There are only two choices for DS surgeons in So. Cal.  The first is Dr. Peter Crookes at USC.  The other is Dr. Ara Keshishian out of Delano (near Bakersfield) but he also does limited surgeries in Glendale.

There are many patients of both doctors who post regularly on the DS Forum here on OH that will be very willing to help you with any doctor or insurance questions you may have.

Thank you for your input.  I had contacted Dr. Keshishian's office and they told me that becuase of my insurance I could not use him.  He does not work out of a COE hospital.  I have not checked out Dr. Crookes.  I'll have to see if USC is a COE hospital and if it is, I suppose I can go there.  I was hoping for something a bit closer to home, but if I have to travel I guess USC is better than going up north.

I'm not completely sold on the DS yet either.  I am still considering a stomaphyx.  My problem is that I did lose over 250 pounds with my RNY which was more than my original surgeon thought I would lose so I consider myself a success on that level.  However after all that hard work I then did everything I wasn't supposed to do.  I drank alot of soda and ate alot of foods I shouldn't and basically I know that my stoma is stretched out. I can tell because everything goes right through me.  I never never never feel full.  I do believe had I stuck to protocal and changed my bad habits I would not have gained back almost 70 pounds.  I'm not even saying that another surgery is the answer.  My surgeon's former nurse feels very strongly that if I go back to basics of protein only for 3 weeks that will bring my pouch back in line.  I just don't know if I'm mentally ready to do that.  Sounds like a cop out I suppose as I do believe that I am responsible for my success or failure and should not blame it on my original choice of surgical procedure.  I stand by my choice at the time and I'm not sorry I had it done for one moment.

Anyway, I've ranted on too long as is.  I will definitely check out Dr. Crooks and thanks for the info.

Stephanie