New to forum...out of options for revision =(

[tysweetpea]

Searching and searching and can't find any surgeon that will perform a revision from RNY to DS...I want to go to Dr K so bad since he is the only one I saw that does this but due to disability I have to use state insurance. I am by Turlock, Ca. No way to pay out of pocket due to medical bills will due to chemo for hubby's term cancer and i have auto immune disease . ..any suggestions ? someone in the DS group on Facebook suggested I get in touch with Diana and Larra in this forum..desperate to feel and look better before my hubby passes and I can take care of my little man better ...the only surgeon that performs a revision in my area with my insurance does a distal (erny)

 

[southernlady]

Welcome, @tysweetpea
I'm tagging @DianaCox and @Larra for you.

 

[hilary1617]

Hello and welcome @tysweetpea . I hope that you can get the revision you need. All the best!

 

[Larra]

I'm sorry you are in such a tough situation.

There are 2 surgeons in CA who do RNY to DS revisions - Dr. K, and Dr. Rabkin of Pacific Laparoscopy in San Francisco. I'm not sure what you mean by "state insurance", I'm guessing Medi-cal?? but to the best of my knowledge neither of these surgeons accepts Medi-cal.
Getting a revision with Medicaid (Medi-cal is just what we call Medicaid in CA) is a huge problem, esp for a revision that so few surgeons do. You could try Dr. Simper in Utah - I don't know if he accepts Medicaid or not. I think Dr. Ayoola in Denton, TX does these revisions but have no idea what insurance he accepts. Keep in mind also that even some surgeons who accept Medicaid will only accept their own state's Medicaid and not from another state.
Now, if you have Medicare (the federal program) that's a different story as Dr. K does accept Medicare.
I wish I had something more helpful and hopeful to recommend.

 

[DSRIGGS]

Welcome and best of luck to you in your battles.

 

[tysweetpea]

I'm sorry you are in such a tough situation.

There are 2 surgeons in CA who do RNY to DS revisions - Dr. K, and Dr. Rabkin of Pacific Laparoscopy in San Francisco. I'm not sure what you mean by "state insurance", I'm guessing Medi-cal?? but to the best of my knowledge neither of these surgeons accepts Medi-cal.
Getting a revision with Medicaid (Medi-cal is just what we call Medicaid in CA) is a huge problem, esp for a revision that so few surgeons do. You could try Dr. Simper in Utah - I don't know if he accepts Medicaid or not. I think Dr. Ayoola in Denton, TX does these revisions but have no idea what insurance he accepts. Keep in mind also that even some surgeons who accept Medicaid will only accept their own state's Medicaid and not from another state.
Now, if you have Medicare (the federal program) that's a different story as Dr. K does accept Medicare.
I wish I had something more helpful and hopeful to recommend.

Hi Larra,


Yes, it is Medi-cal. My husband is disabled and he now has Medicare. I am fighting to get disability so I am stuck with Medicaid. I guess I will need a miracle. I will be like this forever or be forced to do a distal that I dont want

 

[DianaCox]

There is one possibility, but I don't know if it will work because I haven't worked with anyone to try this yet.

I think that if there is no in-network surgeon who can do an RNY to DS procedure (i.e., surgeon who accepts Medi-Cal), you can request that Medi-Cal pay for you to see an out-of-network surgeon and that they take care of the paperwork involved to make it possible for you to see that surgeon (i.e., at that surgeon's full rate). I'm not quite sure how to start that process, but I think as with everything in the insurance world, requesting the RNY to DS revision first and being denied is a necessary first step.

 

[tysweetpea]

There is one possibility, but I don't know if it will work because I haven't worked with anyone to try this yet.

I think that if there is no in-network surgeon who can do an RNY to DS procedure (i.e., surgeon who accepts Medi-Cal), you can request that Medi-Cal pay for you to see an out-of-network surgeon and that they take care of the paperwork involved to make it possible for you to see that surgeon (i.e., at that surgeon's full rate). I'm not quite sure how to start that process, but I think as with everything in the insurance world, requesting the RNY to DS revision first and being denied is a necessary first step.

The first step is to request a consult with an out of network surgeon. I will be denied. Then I would have to appeal. I couldnt even get close to requesting surgery yet until a consult is done =(

I know this because I was attempting to see a Stanford doctor and I was denied because is considered (out of network) but they only do the apollo stitch. UCSF is the other bariatric hospital but they dont take medical out of their county for bariatric and they dont do revisions at all. I wouldnt get anywhere unless I pay for consult with Dr. R or Dr. K out of pocket.

If I do that do you think that one of those doctors would help fight?

 

[DianaCox]

I would go with DrK first, just because he's ornery and seems a bit more willing to fight insurance sometimes.

 

[tysweetpea]

I would go with DrK first, just because he's ornery and seems a bit more willing to fight insurance sometimes.

I am from Northern cali. .so that would be a long trip. .do you approx how much it is for consult?

 

[tysweetpea]

What is your opinion is the most successful revision from a RNY?

 

[DianaCox]

You said you wanted to use DrK - I would do that. His consult fee is quite reasonable, from what I've heard, but you need to ask his office.

 

[tysweetpea]

You said you wanted to use DrK - I would do that. His consult fee is quite reasonable, from what I've heard, but you need to ask his office.

yes Dr. K or Dr. R only because they do revisions from rny to ds. in your opinion do you think this is the most successful revision from a rny?

 

[DSRIGGS]

yes Dr. K or Dr. R only because they do revisions from rny to ds. in your opinion do you think this is the most successful revision from a rny?

It is the only successful revision.

Dssurgery.com is Dr K's website with contact information. I am sure he could Skype or do a phone consultation. Kristina and or Silva are very nice and can answer your questions.

 

[Larra]

Going from proximal RNY (what you have now) to distal RNY has never been shown to increase weight loss by much. Going further, to ERNY (the E is for extended) would get you more weight loss, but would also get you a bad combination of serious malabsorption (like with the DS) but with no use of your pyloric valve - as opposed to having a sleeve with a functioning pyloric valve with the DS. Most of us here consider it the worst of both worlds. In addition, you would still not be able to take NSAIDs, just like now, and any issues you have with your pouch would remain the same.
I think your best bet, unless you can get Medicare, is to consult with Dr. K, get yourself a denial, and go from there, with the understanding that there is no guarantee this will work. And @DSRIGGS has made a great suggestion of a phone or Skype consult to save you a trip, if Dr. K will go for that.