Hello! RNY 21 Years ago; thinking about revision; here for help

Discussion in 'Say hello!' started by Crayon, Sep 5, 2018.

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    Crayon

    Crayon New Member

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    Hello everyone!

    I'm female & 49 years old. I had an open RNY Gastric Bypass and gall bladder removal at the same time in 1997 at St. Joseph's hospital in Burbank. I weighed 275. I no longer remember the surgeon's name though I did recently request my medical records but not sure if they still have them or not. I went down to 180 after RNY but never lower. Now I weigh about 255, BMI 45.2 After the RNY I followed all the directions. I've always faithfully taken my vitamins and supplements, some of them multiple times per day. At my very lowest I was 180 pounds but never went any lower.

    In 2013 I got pregnant at the age of 44 - I actually found out I was pregnant on my 44th birthday and immediately knew that I was going to have this baby AND that it would be born healthy. My first thought was, "Wow.. someone wants to be born." Women my age are spending thousands or hundreds of thousands trying to get pregnant and here I am... So I decided to run with what the universe had seen fit to throw in my path, even though I would be a single parent. (Long story, no child support either!) Children were never in my life plan, but I thrilled with being a mom. Since about 2013 when I was pregnant and after - my weight has really crept up. I'm currently sitting at 255.

    I want to live longer. I want a better life for me AND my daughter who is now 4.5 year old.

    I have been researching and researching all kinds of options and I came across the board a few weeks ago have been peeking around ever since before finally joining today.

    I need a revision, this much is sure, but damnit I have the dreaded Kaiser NorCal.

    Before I could get an appointment with a surgeon, they made me do some class that was for people who've never even had WL surgery, then they said, whoops.. that's not the class we meant. You need to take THIS other class.

    So then I took a half day off work and took a class with the psychiatrist at Richmond, (Dr. Z in NorCal who was actually very nice!) who basically said, "eat your protein first blah blah blah" We've heard it all before. Then, AFTER they made me take the class I got, "We don't do revisions. There's nothing we can do help you."

    So last year I talked to Dr. Rabkin's office about changing health insurance, but with the other option is Blue Cross and I'd have to pay $16,500 up front to him and then they'd reimburse me any fees that were not paid out by insurance. That's a lot, probably more than I can really handle. That's a lot considering I also will have to pay about $7,800 out of pocked for Blue Cross for me+daughter. I have Kaiser now because at my work it is free for me+daughter.

    We are also getting the new Sutter Health for next year and I need to call Dr. Rabkins office to see what the deal is there. Maybe I just pay the higher premiums for a year and then go back to Kaiser.

    So I've been saving for a revision in Mexico. I currently have $8,500 saved. However, I can't find a surgeon in Mexico do to the RNY to DS revision. One of them did scare tactics like my bones will break, I'll have malnutrition, and my I will smell like feces. He even said sometimes people's armpits smell like poop. They have all replied the same, "It is not possible to do a DS , we can reduce the size of your pouch and do longer the alimentary limb." I'm not sure that it would actually effective. I really want the RNY to DS revision, if possible.

    So I came to the board and I discovered that yes, people are able to get revisions with Kaiser if they fight hard enough. What I don't know is if they do RNY to DS conversions.

    Another thing that I had NO IDEA until quite recently - is that maybe there was something wrong with my RNY to begin with. I didn't lose that much weight AND I've had pretty bad heartburn the past 10 years. I mean, so bad I sometimes thought I was having a heart attack. A few times I even had to take off work. I have since learned that if the RNY wasn't done correctly, there could be an issue.

    Since I took the class last year and went away with my tail between my legs - NO MORE! I have an appointment with my Gen Practitioner to talk about the heartburn and see about getting and endoscopy done. THEN I am going to get an appointment with a surgeon, damnit!

    I just want to go through all the steps correctly to fight Kaiser on this! I want to have all my ducks in a row and ready to go.

    Thanks for listening!
     
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    southernlady

    southernlady Administrator Staff Member

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    DianaCox

    DianaCox Bad Cop

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    I'm assuming your frustrating encounter with NorCal bariatrics was over six months ago, in which case you need to start over again to get a formal denial; however, since you HAVE been told NorCal Kaiser bariatrics doesn't perform revisions in your situation, and thus does not have an in-house practitioner qualified to perform the procedure you need, I suggest that you go to your PCP and request a referral to Dr. Rabkin, who does perform the procedure. Preferably, get whatever answer you get to this request (i.e., the denial) in writing.
     
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    hilary1617

    hilary1617 First time at the rodeo.

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    Hi and welcome CrayonCrayon! Congratulations on your surprise baby and your realization that there is no need for your tail to be between your legs. The procedure failed you and not the other way around. You're in the right place. It will be a long journey but the result is well worth it. All the best!
     
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    Crayon

    Crayon New Member

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    Thank you Diana! I have written to my PCP & asked for another referral. She's out of town until Sept 17, but she'll have a backup person reading her emails.

    Tell me if this sound about right to you?
    1. Get the referral to the Kaiser Bariatric Surgeon.
    2. The main point at this appointment will be the Acid Reflux that's been making me so miserable. Would like to find out what's going on in there and if my surgery was done correctly so long ago.
    3. At that time I'm also going to ask about a revision to a DS due to the long term failure of my RNY.
    4. I will ask for his decision in writing.
    5. If I get denied, but Kaiser DOES have a surgeon who can do a RNY to DS, then fight via Kaiser and jump through all the hoops.
    6. If I get denied and Kaiser DOES NOT have a surgeon who can do a RNY to DS, ask my PCP for a direct referral to Rabkin.

    I am hoping to get a bit of advice about how to bring up the RNY to DS conversion to the surgeon in the right way. What are the correct things to bring up, what points to make, etc.

    I've been reading this every waking moment for about a week. DianaCoxDianaCox and LarraLarra you are amazing in all that you do to help folks. I know you've helped change a lot of lives for the better - Just sending you much deserved appreciation.
     
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    DianaCox

    DianaCox Bad Cop

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    I'm waiting for LarraLarra to check in, but I think since you've already been told that Kaiser doesn't do revisions, I don't see that there is any point to going through the process - I would make that argument to your PCP and ask for a referral directly to Dr. Rabkin. It is my understanding that NorCal Kaiser has a contract with Dr. Rabkin to perform the DS on their patients. But your PCP may require you to go through the whole process again - just argue that that would be a pointless detour, interposed solely for delay, since you've already done that, and as far as you know, there has been no change in access to RNY to DS revision at Kaiser since that determination.

    But probably Kaiser Bariatrics has control over the referrals to Dr. R, so you might have to do it anyway. Larra is more familiar with NCK, so let her weigh in first.
     
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    Crayon

    Crayon New Member

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    Well, after posting all that.... I just found out today that we will have a new option for health insurance next year FOR SURE... Sutter Health Plus HMO AND I can swing the extra cost it if I tighten my belt (put intended)! Dr. Rabkin is in the network! Not only that, both he and my old doctor who I will take up with again are in the same Physician's Group. How's that for luck?

    I think I've solved my problem!

    Yes, it will cost me $220/month to have the insurance for a year, my employer pays the rest. I'm on a pretty tight budget as a single mom in the expensive Bay Area, but damnit I'm going to make it work! This way I don't have to fight with Kaiser.

    I'm totally set! Can't wait for Mat to return from vacation to confirm Rabkin will still be in the group next year.
    :geek::geek:

    CROSSING FINGERS!!
     
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    Larra

    Larra Well-Known Member

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    If you do decide to stick with Kaiser, no, they don't have anyone who does RNY to DS revisions, so the only way to get one through Kaiser is with Dr. Rabkin. They are going to deny this for sure, even if the endoscopy (which I agree is a good idea) shows something amiss. The denial would come from someone in the bariatric surgery program, not your pcp, who doesn't get a vote. At that point, you could start appeals, which begins with your internal appeal (called a grievance) and, when internal appeals are exhausted with final denial, you could go to external appeal through the DMHC (dept of managed health care) which would be your only chance of success. It is very much harder to get approval for a revision of any kind than for a virgin DS.

    If at all possible, see if you can get info from the potential Sutter option as to bariatric surgery coverage, and specifically coverage for revisions. Often the criteria for revision is most stringent than for a primary bariatric surgery. If it turns out that there really is something anatomically wrong with your gastric bypass, that would be very helpful in getting coverage. I wonder if this might not be the case, as gastric bypass usually is very effective in relieving GERD. Makes me wonder if you might have a fistula (connection) between the pouch and the blind stomach, but again, you need testing to sort this out.
     
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    Crayon

    Crayon New Member

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    Thank you Lara, I really appreciate your input. I will definitely be looking into the Sutter Health issue regarding revision. I talked to someone in HR today about getting the evidence of coverage before I make the decision during open enrollment and she said I could only get the summary and that the evidence of coverage wouldn't be available until April. That doesn't make a lot of sense to me. I wonder if there is someone at Sutter Health I could call to get the information.
     
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    southernlady

    southernlady Administrator Staff Member

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    Even if Sutter Health said yes, your HR could have opted out of that part. So my advice, proceed ahead but save money for self pay.
     
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    DianaCox

    DianaCox Bad Cop

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    At least get the summary.
     
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    DianaCox

    DianaCox Bad Cop

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    JackieOnLine

    JackieOnLine Moderator Staff Member

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    Hello and Welcome to the board. :)
     
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    DawnNYC

    DawnNYC Active Member

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    I will also add that if you have an option for BCBS and your employer hasn’t opted out, you could look into Dr. Keshishian. He doesn’t have a program fee, nor do you have to pay anything upfront. You are just responsible for your co-pay and deductibles.

    Good luck!
     
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    galaxygrrl

    galaxygrrl Well-Known Member

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    Welcome and happy motherhood. You are signing up for a rough year or two, but it will be so worth it when you take your grandbabies to Disney World. :) I'm only two years out, but the difference in my life is so amazing. The DS is the best thing I've ever done.

    A couple things....

    (1) I would continue to charge ahead with Kaiser as a back up plan. Sometimes people get approved without much of a fuss - we have a couple DS people in Dr Rabkin's group who had Kaiser and had an easy time being approved. You might get approved in the next two months and then, you don't have to tighten your belt. :)

    (2) If you are in the Bay Area you should so come to Dr Rabkin's group next week and meet a bunch of people who had the DS with him. His support group is amazing. It's next Wed.

    San Francisco
    Date: 2nd Wednesday of each month
    Time: 6 PM - Simultaneous Informational Seminar and post-op meeting.
    7 PM - General open meeting for both pre-op and post-op patients.
    Place: Cafeteria at St. Mary's Hospital
    450 Stanyan Street
    San Francisco, CA 94117
    Additional details: Parking is available at St. Mary's Hospital parking at the corner of Stanyan and Hayes Street.
    For more information please call our office

    Again, Diana and Larra are the ones who can help you.

    Good luck.
     

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