insurance will not cover ds only gastric bypass please help

maxie1
on 12/20/12 8:02 am - PA
RNY on 06/10/13

Hi,

  I had the gastric sleeve back in 6/2011.  I was told by another surgeon it was not done right so I need to have a revision.. but my insurance will not pay for the ds.. it will only pay for the gastric bypass... Please help in any way if anyone has any suggestions on how to appeal this decision and for me to get the ds approved...thanks..

susan                                                                                                
southernlady5464
on 12/20/12 8:16 am

Do you require NSAIDS cause the RNY is contraindicated for that and would be a good reason to get the DS.

Liz

Duodenal Switch (Lap) 01-24-11 | Surgeon: Stephen Boyce | High weight: 250 in 2002 | Surgery weight: 203 | Lowest weight: 121 | Current weight: 135 | Goal weight: 135






   

maxie1
on 12/20/12 8:27 am - PA
RNY on 06/10/13

yes i do take a stomach pill for the acid reflux  i had the originial surgery here in pa and i found a dr Greenbaum in nj that is going to do my revision..

susan                                                                                                
southernlady5464
on 12/20/12 8:48 am

Acid reflux is not what one would use an NSAID for...NSAIDS are for arthritis or pain that does not respond to tylonel or aspirin. If you have arthritis or have a strong family history, it's a good reason for the DS.

Liz

Duodenal Switch (Lap) 01-24-11 | Surgeon: Stephen Boyce | High weight: 250 in 2002 | Surgery weight: 203 | Lowest weight: 121 | Current weight: 135 | Goal weight: 135






   

maxie1
on 12/20/12 8:53 am - PA
RNY on 06/10/13

no not on that then,, i have diabetes, high blood pressure, thyroid, asthma i only lost 45 lbs with the first surgery.

susan                                                                                                
southernlady5464
on 12/20/12 8:56 am

Do members of your immediate family have arthritis (most of us do) or a history of migraines, or back issues/knee pain, etc???

Duodenal Switch (Lap) 01-24-11 | Surgeon: Stephen Boyce | High weight: 250 in 2002 | Surgery weight: 203 | Lowest weight: 121 | Current weight: 135 | Goal weight: 135






   

maxie1
on 12/20/12 8:57 am - PA
RNY on 06/10/13

I did have back surgery back in 1992 but i am not on any medicines for it

susan                                                                                                
southernlady5464
on 12/20/12 8:58 am

Maybe not now but who knows what the future brings. I also had back surgery and still needed NSAIDS.

Liz

Duodenal Switch (Lap) 01-24-11 | Surgeon: Stephen Boyce | High weight: 250 in 2002 | Surgery weight: 203 | Lowest weight: 121 | Current weight: 135 | Goal weight: 135






   

MsBatt
on 12/20/12 11:22 am

The DS is the most effective form of WLS for treating diabetes. Try that argument. Also, you already have half of the DS. Adding the intestinal portion should be less risky for you than converting to a less-effective form of WLS.

If necessary, hire a lawyer.

Jaiart
on 12/20/12 10:15 am - MI
What insurance do you have?

 

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