Hi, I am a newbie!

[MamaShelia]

I posted this on another site and heard that I may get some more specific help here! Please read below.

Hello ALL!

I had an RNY in 2000 and am just learning this past summer, via this board, that revisions are "a thing!" I got insurance through my job this year because they had a plan that covered revisions.

My BMI is currently 44.9 and CIGNA requires a BMI of >50 for DS. I have lupus, arthritis, and systolic heart failure as my air co-morbidities.

The 64K questions is: Does that requirement mean for all DSers, or just first time DSers?

I have called the "1800 CIGNA" line 4 times now and the first three agents thought it meant only for first timers, were actually pretty confident of it and made a believer out of me. However, when I called today, another agent said no, it means for all bariatric patients. He had his manager to read over it and the manager agrees. That stinks! There is room for ambiguity and a little confusion on the part of how the requirements are listed, I think.

Anyhoo, has anyone had any recent experience with battling CIGNA and how to proceed?



The guy today mentioned a reauthorization and if it was denied to get the doctor to do a peer to peer call. Do you think it is a BIG DEAL to ask for a peer to peer, or is it pretty common these days? Are there other things I should do first before requesting that?

I have an appointment with Dr. Ayoola (Frisco/Denton, TX) next Tuesday for an in initial consult and just want to know what to expect on my part and what to expect from his office and CIGNA.



All comments, suggestions, and advice are welcome!



Thanks so much!

 

[Dawn]

I don't have any answers for you just wanted to say welcome. I'm sure the amazing peeps on here will have answers for you.

 

[MamaShelia]

Thanks, Dawn!

 

[Larra]

Hey, you found us! Welcome!! When the time comes, DianaCox and I are the people who help out with insurance issues, and Diana has the best understanding of insurance policies. The gang here also know who all the RNY to DS revision surgeons are. So let us know what happens with your upcomming consult and we'll go from there.

 

[DianaCox]

Pretty much most of the time, Cigna's ridiculous requirement for BMI > 50 can be overcome. But a peer-to-peer is pretty normal and can be very helpful in these cases - the doctor can (and this pisses me off) plead how YOUR case is special and requires the DS rather than a lesser surgery.

What I'm more concerned about is Ayoola's experience (or lack thereof?) in doing RNY to DS revisions. He was in training with Stewart when Stewart passed away suddenly, and I don't know how many Ayoola did, assisted on, etc. As much as I endorse Ayoola for virgin DSs and even Lapband to DS revisions (and of course VSG to DS revisions), I don't know his qualifications to do the MOST difficult of all revisions, the RNY to DS.

 

[Barb1]

I'll just say welcome and good luck on getting approved, because you already have the right people helping you!

 

[MamaShelia]

Hey, you found us! Welcome!! When the time comes, DianaCox and I are the people who help out with insurance issues, and Diana has the best understanding of insurance policies. The gang here also know who all the RNY to DS revision surgeons are. So let us know what happens with your upcomming consult and we'll go from there.

YES! I did! Thanks so much, Larra! I will definitely let you know what happens on Tuesday. I am hopeful all goes well: I trust the doctor, he has a track record of performing the revision successfully, and his staff is ready to fight with me and for me! Other than that, I am not afraid to walk away and find someone who will do all all of those things. I am looking to have the revision next summer break (I am a teacher) so, there is still some time.

 

[MamaShelia]

I'll just say welcome and good luck on getting approved, because you already have the right people helping you!

Thanks for the warm welcome, Barb! I feel I am in the right place to get the skinny on my issues! (pun intended!)

 

[MamaShelia]

Pretty much most of the time, Cigna's ridiculous requirement for BMI > 50 can be overcome. But a peer-to-peer is pretty normal and can be very helpful in these cases - the doctor can (and this pisses me off) plead how YOUR case is special and requires the DS rather than a lesser surgery.

What I'm more concerned about is Ayoola's experience (or lack thereof?) in doing RNY to DS revisions. He was in training with Stewart when Stewart passed away suddenly, and I don't know how many Ayoola did, assisted on, etc. As much as I endorse Ayoola for virgin DSs and even Lapband to DS revisions (and of course VSG to DS revisions), I don't know his qualifications to do the MOST difficult of all revisions, the RNY to DS.

Diana, thanks for the honest response. I have heard good things about him, in general, and in this area of revision. I realize how serious all revisions are and especially this one, because my case is indeed special. (Sigh, here goes!) My original surgeon's license was revoked (in NC) several years back for performing mini gastrics instead of full RNYs, but filing it as RNY. So...you can connect those dots! I have had so many stomach and GI issues due to faulty first surgery, that I do feel I am worth fighting for and want the DS--only. And if this surgeon doesn't back me on that to the insurance company (my first one was done under tric care and they now have a one per lifetime clause, although I feel like I could fight them and win..and anyone that they sent to that guy should be allowed a do over! ) Okay, I digress, but I have talked to Dr. Ayoola's office staff and he had done fewer than 100 (80 something) when I asked earlier this year, but I have waited almost 15 years, I am not afraid to walk away, if it doesn't feel kosher.

I will keep you posted!


Thanks again!

 

[DianaCox]

Diana, thanks for the honest response. I have heard good things about him, in general, and in this area of revision. I realize how serious all revisions are and especially this one, because my case is indeed special. (Sigh, here goes!) My original surgeon's license was revoked (in NC) several years back for performing mini gastrics instead of full RNYs, but filing it as RNY. So...you can connect those dots! I have had so many stomach and GI issues due to faulty first surgery, that I do feel I am worth fighting for and want the DS--only. And if this surgeon doesn't back me on that to the insurance company (my first one was done under tric care and they now have a one per lifetime clause, although I feel like I could fight them and win..and anyone that they sent to that guy should be allowed a do over! ) Okay, I digress, but I have talked to Dr. Ayoola's office staff and he had done fewer than 100 (80 something) when I asked earlier this year, but I have waited almost 15 years, I am not afraid to walk away, if it doesn't feel kosher.

I will keep you posted!


Thanks again!

No offense to Ayoola, truly, but PLEASE PLEASE PLEASE consider going to Keshishian or Rabkin in California instead - they will be more likely to be able to deal with the aftermath of your RUTLEDGE BUTCHERY OF A MINI-GASTRIC BYPASS. There, I said it.

 

[MamaShelia]

No offense to Ayoola, truly, but PLEASE PLEASE PLEASE consider going to Keshishian or Rabkin in California instead - they will be more likely to be able to deal with the aftermath of your RUTLEDGE BUTCHERY OF A MINI-GASTRIC BYPASS. There, I said it.

Steven E. Olchowski, actually. =0)

 

[DianaCox]

Hehehe - I forgot about him. I did a Google search of him and Rutledge, and found my own post!

DianaCox
San Jose, CA
Robert Rabkin, M.D.
Duodenal Switch (08/05/03)
Member Since: 12/22/02
[Latest Posts]Post Date: 11/22/09 1:29 am
I'm guessing you mean Rutledge, and yeah, that's him.

Here is some reading for you:
http://www.obesityhelp.com/forums/amos/3689886/Mini-Gastric- Bypass/

Dr. Rutledge had an entire expose done about him doing them as well. It hit not only the papers, but the TV as well before he left the state. Dr. Olchowski was sued so many times he changed his name and left the state.

DOCTOR CHANGES NAME AFTER MALPRACTICE LAWSUITS
Dr. Steven Olchowski was once hailed as a maestro of the gastric bypass procedure. But then the lawsuits began. While practicing at North Carolina’s New Hanover Regional Medical Center, he would tell patients he was to perform one type of gastric bypass surgery. But once in the operating room, he actually did a risky short-cut operation--a mini-bypass--instead, resulting in life-threatening complications afterwards. He did give up his license in NC. But he was already in Michigan starting anew. And to cement the move, he changed his name. Out with Olchowski and in with Hawkins. His attorney said he wanted a fresh start. Don't we all. Try doing that pesky medical background check now. Read [WWAY]


From CNN:Hospital sued over wrong surgeries
A doctor may have performed the wrong type of gastric bypass surgery on more than 50 patients at a Wilmington hospital, officials said. Dr. Steven E. Olchowski performed the surgeries between December 2000 and the spring of 2002 at New Hanover Regional Medical Center, which is facing eight malpractice lawsuits stemming from the weight-loss operations. "We cannot be sure about any conversation in Dr. Olchowski's office between him and his patients," Dr. Samuel Spicer, vice president of medical affairs at New Hanover Regional, said Wednesday. The lawsuits claim Olchowski told patients he would perform a gastric bypass surgery known as Roux-en-Y, which usually is covered by health insurance. According to the lawsuits, he performed minigastric bypass, which usually is not covered. The difference between the surgeries is how the stomach and intestines are attached. Attorneys for six of the patients said their clients had serious complications such as stomach ulcers and required a second surgery to convert the bypass into a Roux-en-Y. It wasn't immediately clear how much the lawsuits sought in compensation. Olchowski, 57, resigned from New Hanover Regional in 2003. He now practices at Ionia County Memorial Hospital in Michigan.


http://www.obesityhelp.com/forums/amos/3379114/Mini-Gastric- Bypass/


Warning Will Robinson!

 

[Whit]

Hi and welcome. Not only is it a "thing" I revised from RNY(2002) to DS in December of 2012. I also had a micro-pouch. It was one of the smallest Dr. Keshishian said he had seen. It sure did not keep me from gaining almost all of the weight I had lost with RNY surgery.

This is not a cookie cutter procedure. I can not stress enough how important it is to go to a vetted DS revision surgeon. Like some I had surgical complications and without the benefit of Dr. K's expertise and ability to "Macgiver" a fix for my situation I may not be here today.

Best,
Whitney

 

[Terri]

Welcome @MamaShelia!

 

[southernlady]

@MamaShelia