Question:
PLEASE I AM BEGGING FOR SOME ADVICE AND RESPONSES ON THIS QUESTION. I have posted

before and noone will respond. I am here in this forum for help and guidance..please..I have had rny done 1/27/2000 i was 510lbs, got down to 280, had a baby, my current weight is 350...MASSIVE and MAJOR pain in my pouch, feels like it is being squeezed like a water balloon, so much pain..Planning a revision, not only to lose weight, but to diffuse the pain, I have an exclusion, of course, and I work for UHC and I have an exclusion, but here is the letter my surgeon plans to send: United Healthcare Bariatric Revision Surgery Policy Policy number: 0000000000 Effective date: January 1, 2012 Surgical revision or a second bariatric surgery is proven for inadequate weight loss if the original criteria for bariatric surgery (BMI, co-morbidities and patient selection criteria) continue to be met. Surgical revision of bariatric surgery is proven for complications of the original surgery, such as stricture, obstruction, pouch dilation, erosion, or band slippage when the complication causes abdominal pain, inability to eat or drink or causes vomiting of prescribed meals. My question is, if WLS or bariatrics of any kind are excluded the letter this way will be denied, correct?? SOMEONE PLEASE ANSWER... :)    — beccacoker74 (posted on June 11, 2013)

July 30, 2013
Not necessarily, the doctor submitting the letter of medical necessity will have to submit a revised diagnosis to the examiner at your insurance company for approval. If you meet the requirements for bmi, nutrition deficiency,stricture or other conditions stemming from the original surgery, your insurance should pay the required portion. I would seek at least two other opinions from two other board certified surgeons and let them know what is going on, they would most likely submit a second and third opinion form to your current surgeon for him to submit to your insurance company.
   — titan51171

November 9, 2013
I do not know about the insurance but I am intersested in knowing about your squeezing pain....I had bariatric surgery on feb 2005 I weighed 460# current weight is @ 290...I have suffered since day 1 after this surgery with violent squeezing of my stomach and or intestines..not sure if it is dry heaves or a nerve problem or both...I am curious to know if you experience the same symptoms My list is extensive as to what might be causing this
   — anorris696

December 13, 2013
It has been a while since you posted this and hopefully you have already been approved but in case not I thought I would share my experience with UHC and revisions. I had a vertical banded gastroplasty (VBG - stomach stapling) in 9/97. I lost weight at a good pace for over 6 months and then it just stalled. I couldn't figure out what had happened but suddenly I started to eat more food more often and yet 15 - 20 minutes after eating would have me watching the clock to see when I might be able to hold more food. The weight started creeping up and I was panicked. My surgeon had washed his hands of me when I first reached out about this problem. I was told that whatever was going on was MY FAULT as there was nothing wrong with HIS SURGERY. This was relayed to me via phone and never once was I seen. I took on the shame and guilt and beat myself up while trying every diet and not getting anywhere. Long story shorter, I finally went and saw a surgeon in late 1999. He scoped me and found that my silastic ring was gone so there was nothing there to hold the food and keep me full. The food would enter the pouch (staples were still intact) and then when it was met with no resistance by the missing band it just dropped on down to the old stomach. That is why I stayed hungry. UHC covered my first surgery and denied the revision due to the one procedure per lifetime clause. My surgeon was able to prove that my surgery was a mechanical failure due to no ring and was not of my doing. After several months they approved the revision and i was able to have a revision to RNY in 5/2000. Hang in there and good luck!
   — Kellye C.

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