doc wont revise to DS. what now?

tracy327
on 6/19/14 1:59 am

I was sleeved in august 2010. I lost about 80 pounds in approx. 9 months and then with no changes to activity or caloric intake I started to gain. Long story short, after doing some research and talking my father into the DS surgery, I decided that perhaps that was the best option for me. Had I known about the DS prior to having the sleeve done, that would've been my first choice. I only learned of it in doing research for the most effective surgery to cure type 2 diabetics. My father had the DS with DR. Greenbaum  and it totally saved his life. YAY! My weight DOS was 255 and I was back at 210. Lowest weight after surgery was 175. The surgeon who did my sleeve did not perform the DS so I went to see Dr Greenbaum. He told me immediately that he didn't think I was a candidate because I was not at least 100 pounds overweight and had no comorbidities. I showed him the copy of Aetna's revision policy which states that a patient is a candidate if he/she hasn't maintained over a 50% loss of excess weight after 2 years. I clearly fit that category. I also felt that I either had a stretched or very large sleeve since I was able to eat a normal sized meal very early on after my initial sleeve surgery. Despite the fact that it was printed in black and white he still seemed skeptical. I asked him if we could go ahead with the approval process, submit the claim and see wha they say. He agreed and I went through the process of sleep study, pulmonary function test,ekg and all that jazz. Once I did all of that and asked him to submit to Aetna, he refused to do so stating that I was not a candidate because I am not heavy enough and have no comorbidities. This was last Spring. I was furious but despite my pleading, he refused to submit. I pumped up my workout routine hitting the gym daily for treadmill time and doing 2 weight circuit training sessions at home. Once in the morning and once at night. I lost and got down to 188 prior to my hubby returning from Afghanistan. I m a teacher so we had about 5 weeks off together with the kids last summer and we were never home. Although I was still counting calories and I was trying to walk/jog as much as possible wherever we were, I quickly began to gain again and find myself now back at 207. I don't mind working for the weight loss but 3 workouts daily is not realistic for me at this point in my life (full time job and 3 small children)  and it seems as thought that's what my body is requiring. I just made an appt with my original surgeon to discuss re-sleeve although I think the DS would be the most effective procedure. Does anyone have any experience or knowledge of either a resleeve or a revision from sleeve to bypass? Also, has anyone else been told they need to be back up to 100 pounds overweight or have comorbidities in order to qualify for revision? Ive tried to call Aetna but they simply redirect me to read their medical policy bulletin. Ive considered contacting another surgeon who does the DS but am also having trouble determining which out of state DS surgeons would be covered by my insurance. I have Aetna HMO. Any advice or insight is greatly appreciated.

Hislady
on 6/19/14 3:36 am - Vancouver, WA

Post this on the DS board and they should be able to help you out. If the DS is what you want don't settle for less. From what I've read resleeving isn't really a good idea since the tissue will be very thin from the original surgery. The DS folks are very knowledgable so check with them.

pineview01
on 6/21/14 1:35 pm - Davison, MI

I would ask on the DS boards and find a surgeon willing to take your insurance and submit.

BAND REMOVED 9-4-12-fought insurance to get sleeve and won! Sleeved 1/22/13! Five years out and trying to get that last 15 pounds back off.

Whit
on 6/22/14 2:38 pm
Revision on 12/10/12

Dr Ara Keshishian preformed my revision. He is a vetted revision surgeon. Don't give up.

Good luck

Revision from RNY to DS 12/10/12 Dr. Ara Kesishian BMI: 19

Created by MyFitnessPal - Nutrition Facts For Foods

 

 

 

          

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