Other than having to have two surgeries, two recoveries, and the added risk of going under twice, are there any reasons it would be better to do it all at once rather than in two steps? Of course I'd rather everything at once, but if I could more quickly get sleeved through insurance and then save up to self-pay for step two, is there a significant downside to doing that versus waiting to do it all? I also had one doctor who said he felt with my band revision I'd be under too long to do it all at once. I've seen the word synergy but don't know what that means in this context.
Duodenal switch all at once or in steps?
- Thread starter Ellie Mae
- Start date
harrietvane
Well-Known Member
No reason at all. I was a band to DS revision, and unless there's a lot of scar tissue it's very doable. My surgeon said it was a possibility that all he'd be able to do was remove the band, but it seemed as if that was a 'cover your ass' worst case scenario warning he gives. That said, your self pay difference is going to be pretty minimal between the two surgeries, so you won't save too much.
Is medical financing or a personal loan a possibility? The only regret most people seem to have is waiting as long as they did to get it done. Though I thought someone else said in the previous thread that, with your insurance type, beware of self-pay for fear of lack of coverage later down the line.
Is medical financing or a personal loan a possibility? The only regret most people seem to have is waiting as long as they did to get it done. Though I thought someone else said in the previous thread that, with your insurance type, beware of self-pay for fear of lack of coverage later down the line.
It's not about the difference in cost between the two. I found that a military treatment facility near me does the Sleeve, but not DS. I also have been told that Tricare is unlikely to approve the DS. I'm still shooting for all at once. Hoping to be ready to submit to insurance by next week. But considering I've been told to expect to be denied, I'm trying to look into other options.
I could save up for the DS in Mexico unless someone knows of a doctor in the US that would do self-pay for around 11,000. Either way, it would be next year before I could get it done in that case. The other poster said out of the country is what I shouldn't do with my insurance. I hope that isn't true because I got my band in Italy!
I could save up for the DS in Mexico unless someone knows of a doctor in the US that would do self-pay for around 11,000. Either way, it would be next year before I could get it done in that case. The other poster said out of the country is what I shouldn't do with my insurance. I hope that isn't true because I got my band in Italy!
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harrietvane
Well-Known Member
Have a look at Gagner in Montreal. His was around USD$14,500 for the DS, which was cheaper than anyone I found in the US (I was paying in SGD, which is closer to CAD, which eased the pain compared to USD). I wish you luck either way, though I'd personally only want one round of recovery to deal with.
She can not go out of country for the DS to receive aftercare with her insurance. Tricare (the military's insurance) is a bitch to work with.
@Ellie Mae was your band done thru a military facility? If so, it was considered done on US soil regardless of where it was done.
No, it was not done at a MTF. Franco Favretti in Italy. We stayed at a military base there, and he did visit me after the surgery in our quarters on the post. But otherwise, completely non military related. I've never heard of this being a potential issue. Will tricare even ask? One doctor suggested I self-pay to get the band removed which wouldn't be too much, around $6000. I wonder if I should do that?
Munchkin
Full of Fairy Dust
I met a man who was over 800lbs and he had the full DS in 1 OP. Rabkins/Baltasar have done the DS LAP in patients over 600lbs. Unless you are in terrible shape, and you will know if this is you, there is no reason to do the OP in 2 separate surgeries. If your surgeon does not have the SKILLS to do this, I would look for another surgeon or suggest he have another surgeon assist him/her. Gagner wrote about this and he prefers to do 2 ops. PREFERS...meaning it's easier for him. He gets paid twice and the patient has to go through this whole thing twice. Plus there is a chance after the patient gets the sleeve, they will be denied the switch by their insurance company. This has happened multiple times.
Now let's talk about synergy. No one knows for sure why but 1 OP patients lose more, faster, than the 2 OP patients. And it's easier. They don't have to work quite as hard to lose the weight. There are 2 OP patients who made it to goal so it's not impossible. But your best chance is 1 surgery, not 2. There is something about having it all done at once that makes it more effective. I think it was @DianaCox who first used the word synergy and she was exactly right! It just works better when it's done all at once.
Here's yet another alternative. Get the band removed now. Some docs will do this in their office. Not a big deal and you have an owie for a couple days. Wait a few weeks, then have the whole DS. Honestly, band removal is usually an easy straightforward procedure. It doesn't take a long time and in the big scheme of things, it should have no bearing on your ability to be under anesthesia for the DS. This is just so you know there is an alternative.
Now let's talk about synergy. No one knows for sure why but 1 OP patients lose more, faster, than the 2 OP patients. And it's easier. They don't have to work quite as hard to lose the weight. There are 2 OP patients who made it to goal so it's not impossible. But your best chance is 1 surgery, not 2. There is something about having it all done at once that makes it more effective. I think it was @DianaCox who first used the word synergy and she was exactly right! It just works better when it's done all at once.
Here's yet another alternative. Get the band removed now. Some docs will do this in their office. Not a big deal and you have an owie for a couple days. Wait a few weeks, then have the whole DS. Honestly, band removal is usually an easy straightforward procedure. It doesn't take a long time and in the big scheme of things, it should have no bearing on your ability to be under anesthesia for the DS. This is just so you know there is an alternative.
Munchkin
Full of Fairy Dust
6K for band removal???? Shop! Get more/other prices.
Thank you! Good info!
harrietvane
Well-Known Member
@Munchkin: Gagner never mentioned two stages as preferred to me, actually. It was only if adhesions from the band removal were going to take an excessive amount of time under anaesthesia that he warned me it might be a possibility. And he was in no doubt that I wanted to him to push for one op on the day - which is what I got, a 4.5 hour surgery.
Larra
Well-Known Member
- Joined
- Dec 31, 2013
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@Munchkin gave you good advice overall, but not about the lap band removal. This is done in the OR under general anesthesia, laparoscopically. Unless there is a complication or some unexpected finding (such as band erosion into your stomach) you would be able to go home the same day. It's only the fills and unfills that are done in the office, with the patient awake.
It is almost always possible to remove the lap band at the same time as doing the DS or at least a sleeve, again unless there is something else going on such as band erosion or severe adhesions. So if the band itself isn't causing problems, there is probably no reason to get it removed without having something more done, unless Tricare would pay for it but nothing else, or some personal reason.
if you're willing to travel, check out Dr. Martin (or maybe it's Martins) in Washington, a military surgeon who does the DS. Ii don't know any other way to get Tricare to pay for your surgery. And as I'm sure you're aware, the military has its own rules and isn't under the same governance as the insurance companies we fight all the time.
It is almost always possible to remove the lap band at the same time as doing the DS or at least a sleeve, again unless there is something else going on such as band erosion or severe adhesions. So if the band itself isn't causing problems, there is probably no reason to get it removed without having something more done, unless Tricare would pay for it but nothing else, or some personal reason.
if you're willing to travel, check out Dr. Martin (or maybe it's Martins) in Washington, a military surgeon who does the DS. Ii don't know any other way to get Tricare to pay for your surgery. And as I'm sure you're aware, the military has its own rules and isn't under the same governance as the insurance companies we fight all the time.
Not sure what technical failure means, but I did what I was supposed to. It was just awful! As for the term "covered procedure", I believe the lap band was covered at the time. Ironically, I didn't meet the criteria because I only weighed 235 and had no other health issues. Now I'm over 300. The yo yo dieting has shot my metabolism.
