Crap band removal approved but DS denied.... Help!
- Thread starter Amey
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After all of this settles down (and by that I mean, after you have gotten your PROPER DS from Simper), I want to help you file a complaint with the Utah Medical Licensing board against Cottam. Your "Informed Consent" is anything but, and their treatment of you was unprofessional in the extreme. And those other patients who are just now finding out (too late) what was done to them should get themselves to a class action attorney, as well as filing complaints to the Utah Medical Licensing board. http://www.dopl.utah.gov/investigations/complaint_form.html
Amey
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Sounds like a plan! I am sure the other 3 are not the only ones.... I can only imagine in 2 years how many he has done this to. I will let you know how things go... And stay active here on the forum. Thank you for all your help. If I need help with an appeal I will definitely be sending up the bat signal again.
Cottam isn't the only one. Enoch's patients have complained too - and look at Jawad's site (quickly, because I do believe it may be changed soon): http://www.jawadmd.com/services/non-surgical-weight-loss/
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Duodenal Switch
The duodenal switch is a type of combinedmalabsorptive and restrictive weight loss surgery. The duodenal switch is known by multiple names, including DS and biliopancreatic diversion with duodenal switch. This surgery decreases both the quantity of food that can be accommodated by the stomach and the number of calories that can be absorbed and used by the body.
The duodenal switch combines the creation of a moderately sized stomach pouch with bypassing part of the small intestine. This allows the patient to lose weight without significantly altering their eating habits. The stomach is able to hold approximately five to six ounces of food, while other common procedures typically leave it able to hold one half to one full ounce.
Duodenal Switch Procedure
The duodenal switch procedure is performed in a hospital or a surgery center, usinggeneral anesthesia. A laparoscopic procedure, the surgery begins with multiple half-inch long incisions in the area of the stomach and middle of the abdomen.
The stomach remains attached the first segment of the small intestine, the duodenum, which is then separated from the rest of the small intestine. The duodenum is then attached to the lowest part of the small intestine, bypassing the majority of the second and third segments of the small intestine.
The surgeon determines that there are no areas that are leaking, and then the instruments are withdrawn and the incisions are closed, typically with absorbable suturesor sterile tape.
After Duodenal Switch
Duodenal switch surgery has excellent results, with the average patient losing 70 to 80% of his excess weight in the two years that follow the procedure. However, patients who choose this type of surgery are at much higher risk for nutritional deficiencies than with other types of weight loss surgery. Nutritional supplements, including vitamins and minerals, will be necessary for the lifetime of the patient.
The procedure was expected to be an improvement on biliopancreatic diversion (BPD), an older procedure. Surgeons believed that by preserving the pyloric sphincter that closes the bottom of the stomach, food would have an opportunity to be better digested, decreasing the level of malnutrition and vitamin deficiencies and preventing dumping syndrome after surgery. However, studies have shown that there is no difference in the rates of malnutrition following the two surgeries.
Long-term, most patients who choose this type of surgery end up with lasting results. Because the body is unable to digest all of the food taken in, lifestyle changes are not as crucial as they are with other types of bariatric surgery. In addition, patients are able to eat substantially larger portions than those who have other types of restrictive weight loss surgeries, allowing for greater patient satisfaction.
Copied:
Duodenal Switch
The duodenal switch is a type of combinedmalabsorptive and restrictive weight loss surgery. The duodenal switch is known by multiple names, including DS and biliopancreatic diversion with duodenal switch. This surgery decreases both the quantity of food that can be accommodated by the stomach and the number of calories that can be absorbed and used by the body.
The duodenal switch combines the creation of a moderately sized stomach pouch with bypassing part of the small intestine. This allows the patient to lose weight without significantly altering their eating habits. The stomach is able to hold approximately five to six ounces of food, while other common procedures typically leave it able to hold one half to one full ounce.
Duodenal Switch Procedure
The duodenal switch procedure is performed in a hospital or a surgery center, usinggeneral anesthesia. A laparoscopic procedure, the surgery begins with multiple half-inch long incisions in the area of the stomach and middle of the abdomen.
The stomach remains attached the first segment of the small intestine, the duodenum, which is then separated from the rest of the small intestine. The duodenum is then attached to the lowest part of the small intestine, bypassing the majority of the second and third segments of the small intestine.
The surgeon determines that there are no areas that are leaking, and then the instruments are withdrawn and the incisions are closed, typically with absorbable suturesor sterile tape.
After Duodenal Switch
Duodenal switch surgery has excellent results, with the average patient losing 70 to 80% of his excess weight in the two years that follow the procedure. However, patients who choose this type of surgery are at much higher risk for nutritional deficiencies than with other types of weight loss surgery. Nutritional supplements, including vitamins and minerals, will be necessary for the lifetime of the patient.
The procedure was expected to be an improvement on biliopancreatic diversion (BPD), an older procedure. Surgeons believed that by preserving the pyloric sphincter that closes the bottom of the stomach, food would have an opportunity to be better digested, decreasing the level of malnutrition and vitamin deficiencies and preventing dumping syndrome after surgery. However, studies have shown that there is no difference in the rates of malnutrition following the two surgeries.
Long-term, most patients who choose this type of surgery end up with lasting results. Because the body is unable to digest all of the food taken in, lifestyle changes are not as crucial as they are with other types of bariatric surgery. In addition, patients are able to eat substantially larger portions than those who have other types of restrictive weight loss surgeries, allowing for greater patient satisfaction.
Larra
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If you look closely at that illustration (by enlarging it, I mean) you can see that this is copied from Dr. K's illustration of single loop Ds. It even says that on the diagram. Yet Dr. Jawad doesn't mention this. You have to know to look for it, or get lucky and spot it, AND you have to know that there is such a thing as a single loop DS. The average patient just learning about surgical options won't have a clue.
Also, where he gets the idea that the modern DS didn't fix most of the nutritional issues of the old BPD is a mystery to me. There is a good reason why the DS is a standard of care bariatric surgery and the old BPD isn't, and isn't being done any more. The rate of malnutrition after the DS is remarkably low - the 10 year follow-up study by Hess and the 15 year follow-up study by Marceau clearly demonstrate how well most DS patients do nutritionally, and with Hess specifically, that most of the few patients with nutritional problems were noncompliant.
Regarding Dr. Enoch, I saw someone on another website state that he had done the full DS lots of times. This was certainly news to me! Makes you wonder how many patients there are old there who don't know what operation they got.
Also, where he gets the idea that the modern DS didn't fix most of the nutritional issues of the old BPD is a mystery to me. There is a good reason why the DS is a standard of care bariatric surgery and the old BPD isn't, and isn't being done any more. The rate of malnutrition after the DS is remarkably low - the 10 year follow-up study by Hess and the 15 year follow-up study by Marceau clearly demonstrate how well most DS patients do nutritionally, and with Hess specifically, that most of the few patients with nutritional problems were noncompliant.
Regarding Dr. Enoch, I saw someone on another website state that he had done the full DS lots of times. This was certainly news to me! Makes you wonder how many patients there are old there who don't know what operation they got.
Larra
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@Amey it sounds like things are back on track. Dr. Simper has an excellent reputation. Document EVERYTHING, every single contact with your insurer especially, and stay cool. If there is a problem we will help you as best we can.
And you did dodge a bullet. It must not have felt like it at the time, but now you know so much more.
And you did dodge a bullet. It must not have felt like it at the time, but now you know so much more.
Amey
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Yes.... So thankful I dodged that bullet... And flabbergasted at how these doctors are able to keep doing this. I know things will take longer, it's not going to be the 2 month start to surgery time frame I was told it would be.... But this for the rest of my life and I want to be around to watch my grandkids grow up so I want to get this right... Even if it means that it's going to take longer.
Spiky Bugger
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Just stopping by to call Bullshit on that Darren dude's comments.
My band was removed and my DS performed, all at once, under Blue Cross insurance. Many others have had the same kind of one-step revision, covered by insurance.
I suspect that the reason he doesn't see it done that way is because that office doesn't write up their documentation very well.
My band was removed and my DS performed, all at once, under Blue Cross insurance. Many others have had the same kind of one-step revision, covered by insurance.
I suspect that the reason he doesn't see it done that way is because that office doesn't write up their documentation very well.
Amey
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Thanks @Spiky Bugger..... I'm just learning the ropes and jumping through lots of hoops... Hoping and praying it will all work out for the best.
A bunch of vets have your back on this. You have to do the work, do the waiting, and undergo surgery - but we've got your back when you have doubts about what you are doing and how. You will be glad you dodged that bullet - and I hope will be the good example for others who are not up to fighting for their right to have the right surgery with the right surgeon.
newanatomy
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You rock!
Amey
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I just talked with Dr Simper's office. They called my insurance and BC told them that revision for bariatric surgery is excluded except where it's a life or death situation. They didn't the medically necessary part that is in their provider document of course. They want me to talk to their insurance specialist on Monday. I'm having a blood test for diabetes tomorrow and am appt with the surgeon that operated on my knee 5 years ago to document the arthritis in my knees and possibly my hips. At this point I'm beginning to feel like it's all for nothing and I'm just going to hit road block after block. I'm really trying to stay positive but it's hard. My PCP waves me to write the referral letter and then she will tweak it and sign it... I guess that's a good thing but I have no idea what to say or how to say it. Any ideas @DianaCox for what PCP referral letter should say? I still don't know when for sure the new surgeons will be in Blackfoot (local hospital) or if the so DS or how many they have done. I'm waiting for the insurance specialist at their clinic to get that info for me. By nature I'm not a patient person but I'm trying. I really appreciate all the feedback and help from everyone. This site has done a lot to keep my sanity in check while I wait and wait some more. I wish I could be doing something constructive in the meantime...other than reading and researching. Thanks everyone!
"They called my insurance and BC told them that revision for bariatric surgery is excluded except where it's a life or death situation."
Well, that was what I pointed out earlier: "For [c] reversals or revisions of Surgery for obesity except when required to correct an immediately life-endangering condition."
This is in essence a one-bariatric-surgery-per-lifetime exclusion. You could appeal and point out to them that
So the answer is yes, it is an exclusion, but you should still appeal it.
@Larra has a draft "template" for preparing your LOMN.
Well, that was what I pointed out earlier: "For [c] reversals or revisions of Surgery for obesity except when required to correct an immediately life-endangering condition."
This is in essence a one-bariatric-surgery-per-lifetime exclusion. You could appeal and point out to them that
- You were SOLD a defective surgery (crapband) that now is known to be so ineffective that many surgeons and insurance companies are ceasing to offer it - that is not your fault.
- Removing your crapband IS a life-endangering necessity because of the potential for esophageal cancer.
- The ASMBS has issued a position statement about revision bariatric surgery which completely opposes the propriety of this limitation: http://asmbs.org/resources/systematic-review-on-reoperative:
- "Based on the Task Force’s review of this complex issue and careful evaluation of the quality and content of the available evidence, additional guiding principles and future directions to clarify this topic are offered:
- Morbid obesity is a chronic disease and acceptable long-term management after a primary bariatric procedure should include the surgical options of conversion, correction, or other adjuvant therapy to achieve an acceptable treatment effect in cases of weight recidivism, inadequate weight loss, inadequate co-morbidity reduction, or complications from the primary procedure.
- “One bariatric procedure per lifetime” and other coverage policies that limit or prohibit reoperative bariatric surgery are not consistent with coverage policies provided for any other chronic disease process, and should be abandoned where they exist."
- "Based on the Task Force’s review of this complex issue and careful evaluation of the quality and content of the available evidence, additional guiding principles and future directions to clarify this topic are offered:
So the answer is yes, it is an exclusion, but you should still appeal it.
@Larra has a draft "template" for preparing your LOMN.
Amey
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Thank you!! I'm beginning to realize this is going to take months and months of appeals and not just a simple request and approval. I know I need my bands out ASAP bit In scared if I top ahead with that without the revision at the same time they will count it as the 1 time deal and deny the DS later. I had a different ins when I got my band so they can't claim that was my 1 time thing.
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