Munchkin
Full of Fairy Dust
LISTEN to these people^^^
You need to get a copy of your Evidence of Coverage (your actual insurance contract, about 100 pages, that explains coverage and exclusions in DETAIL, as well as the appeal procedures), as well as their bariatric policies. Then you need to figure out which bariatric surgeons they cover.
Teel is gone, and if I recall correctly, good riddance. Siddiqui sounds familiar to me, but I'm not sure how much we know about him.
Never, EVER trust what some low level insurance employee tells you over the phone. EVER! They know nothing about bariatric surgery (with rare exceptions) it's all the same to them. They just answer you as fast as they can so they can move on to the next person in the line. No one cares about this as much as you.
Dr. Siddiqui is a vaguely familiar name, though I'm not sure why. If you are interested in him as a potential surgeon, make very sure he does the DS, AND that he does revisions even though revision from sleeve is done by all the DS surgeons I can think of, AND make sure he does the real DS and not something variously called loop DS/aka SADI/ aka SIPS, that is not the same as a DS but some surgeons are calling it the DS. There are strange things that go on in the world of bariatric surgery, and you need to know this and ask the right questions.
You have to have over 10 posts and then the automatic system that runs in the background has to run AFTER your 10th one for you do post links. We did that to stop spammers. It's a pain to newbies but still a necessary pain.I would link to it but I can't post links yet
You're going to need to get clarity on whether Schumacher has experience revising sleeves as well - he's more likely to have encountered that (so many sleeves done, so often they fail ....), but I would like to hear numbers - REAL numbers! - about how many revisions and DSs he's done, since we haven't heard of him as a DS surgeon in the first place.
If it turns out that there is NOBODY in network qualified to do a revision (willing or able to revise the sleeve AND do the DS), you should still be able to request referral to an out-of-network surgeon who IS qualified to do the procedure. The DS is a state of the art procedure, and you should be entitled to be able to choose the best procedure for your medical condition, in consultation with your doctor, even if it is not offered in-network. That is the case with employer-paid HMO plans, and should be the case with Medicaid plans as well.
Ok so I had my sleeve "revised" to the DS on July 5th. The first thing I did was call my insurance company and see if it was covered (some of the staff are actually knowledgeable I see you got one at medicaid who wasn't I do not have medicaid fyi) Get yourself a list of bariatric surgeons in your area and find out who is in network, while you are at it also find out what the procedure code would be considered for the surgery. So when you call back to your insurance company you can find out if that code is covered and by which surgeon etc.
@Butterfly there is one doc at the Cleveland Clinic who has done the DS, but it's definitely not what their group does on a regular basis, and I have no idea where his criteria are, or whether or not he does revisions from VSG (I still think that guy who won't revise someone else's VSG to a DS is losing out, but that's his decision).
Anyway, the doc I've heard of is Dr. Schaur. I might have his name spelled wrong, but I'm close. You may encounter a strong bias towards revising to gastric bypass instead, I don't know, so stick to your guns.