Revision - RNY to DS - Seeking Others Who Have Traveled This Road

Discussion in 'Revisions' started by Investigating Karen, Feb 13, 2017.

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    Investigating Karen

    Investigating Karen New Member

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    Hi, I'm Karen and I'm new here.

    I had the RNY in 2008. I was 300 lbs - I lost 130 lbs and never reached goal. I have regained 30 lbs and consulted with Dr. Ayoola about a revision. My BMI is surprisingly too low for my insurance company (they require 50 or above, mine is 36-almost 37). Dr. Ayoola's office has started me with all the hoop-jumping to get to the point where they can ask for the revision, probably be denied, and then appeal. Has anyone else walked this road - and what has your experience been - not only with insurance covering a revision - but physically - how did you do with the revision itself? I'm in the investigation stage - so all information is appreciated. I'm reading as fast as I can :) Thanks!
     
    Last edited: Feb 13, 2017
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    southernlady

    southernlady Administrator Staff Member

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    Welcome @Investigating Karen@Investigating Karen
    I am not a revision but above 50 is horseshit. THAT can be fought. However, unless you have comorbids, 40 is the low end. @DianaCox@DianaCox and @Larra@Larra are the ones you need to talk to for help.

    Btw, my BMI was all of a 35.2 with a virgin DS. Medicare AND the NIH say over 40 for all standard of care procedures and 35 and above for those of us with comorbids.
     
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    southernlady

    southernlady Administrator Staff Member

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    BTW, what you will need is your Evidence of Coverage (about an 80-100 pages). It is NOT the summary. You may have to get it from your employer's HR dept. And you need a copy of the denial letter for those two ladies to help.
     
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    Investigating Karen

    Investigating Karen New Member

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    Thanks for your replies - my diabetes disappeared shortly after my RNY - however, my hypertension is back. I'd like to hear also from a physical standpoint from others who have had a revision - what they went through, how they felt, how discarding everything you know and re-learning a new system went for them.
     
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    Larra

    Larra Well-Known Member

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    Welcome!
    The policy may have different criteria for a revision than for a virgin DS. That's another reason you need to read the EOC for yourself. Also, you need to know what appeals rights, if any, you have, and that will be somewhere in the EOC also.
     
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    Investigating Karen

    Investigating Karen New Member

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    Thank you, both.
     
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    Settledownnow

    Settledownnow Well-Known Member

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    There are several of us RNY to DS'ers on the board. If you do a search you can find my experiences, and those of others as well. You might also check some of the other WLS boards on the internet. The RNY to DS conversion is risky, and things can go wrong even with the best surgeons.
     
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    Investigating Karen

    Investigating Karen New Member

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    **UPDATE** I got a call yesterday that I was approved for my revision. I'm looking to schedule it next month, hopefully! I can't believe it didn't start off with a denial right off the bat. Hooray!
     
    Caitlunn, hilary1617, Jahni and 4 others like this.
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    Charris

    Charris Well-Known Member

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    I was a distal rny to DS. I was told Cigna would deny me because my bmi was not 50. but they didn't!
     
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    DianaCox

    DianaCox Bad Cop

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    Excellent! Congratulations!
     
    tysweetpea likes this.
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    SVCowan99

    SVCowan99 New Member

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    Interesting. I just had a revision from RNY to DS with Dr. Ayoola. When I first started the process, it was open enrollment for insurance and I was tempted to switch from United Health Care to Cigna because the pre surgery diet was 3 months instead of 6 month. The insurance specialist at the time told me that Cigna DOES NOT approve for DS if the BMI is under 50. No exceptions, and appeals have been lost. I would advise anyone to investigate carefully both the companies health documents and the insurance company coverage documents.
     
    Last edited: May 12, 2017
    Charris likes this.
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    Larra

    Larra Well-Known Member

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    Congratulations! Now get that surgery done before they change their minds.
     
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    Jahni

    Jahni New Member

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    I'm having problems with anyone listening to me let a lone helping me with revision surgery
     
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    Jahni

    Jahni New Member

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    I'm Happy 4 u I hope all goes well
     
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    Kerry Johnson

    Kerry Johnson Sweating

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    I'm a revision; but from a 1980 stomach stapling mess; a sort of RNY that almost killed me; back then they didn't cut the stomach, just stapled it off and then looped the intestine up to the stapled off pouch. Problem was that the stomach doesn't grow together that way and the stapled pulled and tore my stomach and I almost bled to death. Got a transfusion to save my life with was loaded with Hep C.. Yeah, I had Hep C but didn't know it until 1996... Anyway I was lucky and was cured and then in 2008 I had had enough and found Dr Rabkin in San Fran and he pulled all my guts out and re-plumbed the whole mess. It had to have been one of the most difficult he had done; the first surgery took 10 hours, but there was a problem and he had to go back in two days later.. I had so much scar tissue and so many adhesions he missed a small flap of scar tissue that blocked the duodenum. That one was only 8 hours. Anyway it was really sucky to recover from all that, but it has been well worth it; I'd do it again and again no question. The only thing I would do different is not wait so long.

    I'm not up on which Docs are up to the task of revision, but they need to be very good at their craft it is much more difficult than a virgin DS. Mine was open; I was cut from belly button to sternum; but as I understand; many can get it done now lap and if that's possible it will help the recovery tremendously.

    All I can say is make sure your cutter is up to the task then git er done! No clue on insurance, I had to pay out of pocket for mine; at the time it was $35k if I remember right and I figure I'm worth more than that so it was a great investment.
     

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