Hello! Approved for revision, but wanting DS over RNY

[Diana S.]

Hello! I had a VSG in 2005 and went from 342 to 215. Over the years my weight has been creeping back up and then I became pregnant. I had my little one and have been maintaining a weight of 285 for the last year or so. Talked to my Kaiser PCP about a referral to the Bariatric Center, and had my appointment on Dec 1st. Bariatric surgeon approved me for a revision to RNY (specifically to treat GERD) but I don't like what I've read of RNYs. I'm pushing for DS more so because of the long term success and also because natural structures are left in place (the pyloric valve) which the RNY completely bypasses, favoring a hole punched directly into the stomach wall.

Scheduled for a fluoroscopy, blood work, and a mandatory nutrition class, as well as losing 10 pounds. After that a psych eval and schedule a date for surgery. Somewhere in there I need to make my plea for the DS without pissing off my surgeon. But I have something of a game plan for that too.

For the record, I have NorCal Kaiser through CalPERS. That seems to have made a HUGE difference in the initial stages here.

 

[Marquis Mark]

Hi Diana,

Different numbers, but my story is similar to yours. I was also offered a sleeve to RNY revise, but decided to go with the DS. There is one surgeon in the Kaiser So-Cal system who does them -- Dr. Belzberg. He is excellent. It's been about a year and, overall, I'm doing very well.

Larra knows the Nor-Cal Kaiser better. Maybe you can private message her and she can help you out. You might also try searching those keywords. I think she may have posted about it somewhere.

Welcome. You came to a good place.

Mark

 

[Diana S.]

Thank you Mark! I've actually been in touch with Larra (omg she's an amazing wealth of knowledge!) and she actually directed me over here

I am currently searching and reading everything I can. That's my way when I don't trust what "experts" say. I wish I didn't think doctors had an agenda all their own that generally doesn't line up with mine :/ But as my dad said, "you have to know their job better than they do. Take charge of your health!"

 

[Marquis Mark]

Thank you Mark! I've actually been in touch with Larra (omg she's an amazing wealth of knowledge!) and she actually directed me over here

I am currently searching and reading everything I can. That's my way when I don't trust what "experts" say. I wish I didn't think doctors had an agenda all their own that generally doesn't line up with mine :/ But as my dad said, "you have to know their job better than they do. Take charge of your health!"

Yep, and if you get the DS, you will definitely know more about it than most doctors do. In other words, you will have attended "DSU." In fact, Dr. Belzberg told me before surgery that he wouldn't perform it on anyone who doesn't know more about it than he does. It was oddly reassuring.

I can't speak for the Nor-Cal system, but down here it seems like it's pretty much up to the doctors. If you want an RNY revise you complain about GERD. I told them I needed to take NSAIDS for arthritis in my neck (true) which pretty much ruled out the RNY. I don't know what your situation is, but that may help you.

 

[Diana S.]

I can't speak for the Nor-Cal system, but down here it seems like it's pretty much up to the doctors. If you want an RNY revise you complain about GERD. I told them I needed to take NSAIDS for arthritis in my neck (true) which pretty much ruled out the RNY. I don't know what your situation is, but that may help you.

That might be my angle then. Instead of focusing on my reflux, I can put more of an emphasis on my orthotic hardware issues and plantar fasciitis. Perhaps that will sway the decision-makers in my favor.

Thanks!

 

[DSRIGGS]

Don't worry about pissing off the surgeon. You have to live with your surgery and not him. The DS works and the RnY fails many, many patients. Best wishes for you and your efforts to get the DS.

BTW Larra is awesome and was so glad that I was able to meet her in person when I had my DS revised by Dr K in Glendale. She drove down to see her brother but I like to think that was just an excuse to meet me.

 

[DianaCox]

Larra and I know how to beat the NorCal bariatric machine, generally - we have fought them successfully for about 10 years now.

The small potential issue is whether the CalPERS plan has any tricky angles, because it is self-funded. You need to get your Evidence of Coverage document so we can see if any of the issues like the one we had with another patient who had insurance through CalPERS (but BCBS, as I recall) crop up (HAD to use a specific BCBS Center of Excellence, which which the surgeon was not affiliated - we still beat them).

Just wanting to issue-spot, not worry you too much - Kaiser has a different structure, and I don't think the self-funded nature of the CalPERS insurance matters as much as it did for the BCBS plan. But getting the EoC is important.

 

[Diana S.]

Larra and I know how to beat the NorCal bariatric machine, generally - we have fought them successfully for about 10 years now.

The small potential issue is whether the CalPERS plan has any tricky angles, because it is self-funded. You need to get your Evidence of Coverage document so we can see if any of the issues like the one we had with another patient who had insurance through CalPERS (but BCBS, as I recall) crop up (HAD to use a specific BCBS Center of Excellence, which which the surgeon was not affiliated - we still beat them).

Just wanting to issue-spot, not worry you too much - Kaiser has a different structure, and I don't think the self-funded nature of the CalPERS insurance matters as much as it did for the BCBS plan. But getting the EoC is important.

Love your name!

I have the EOC but it says little more than WLS is covered: ugh I can't post the link. Google searching "Kaiser EOC CalPERS" brings up a PDF that's the same document they sent me in the mail.

I did call member services and she was able to give me a little more information, but you could tell she wasn't familiar with any of these terms. She said four procedures were covered (VSG RNY LapBand and DS) and that included "repeat surgeries" when I asked about revisions. She said the only stipulations were that they were "medically necessary" and the completion of the preparatory program.

Beyond that, I've been trying to scour the internet for more specifics and I can't find more than that. To say they're being super vague is an understatement!

 

[DianaCox]

You download the EoC and email it to Larra and me ... I'll start a conversation to send you my email.

 

[galaxygrrl]

Diana and Larra will take care of you. They are really good. Glad you ended up here. Stand firm on the DS. It's so much better.

Also, for the DS, kaiser will send you to Dr. Rabkin. He has an awesome group. If you can you should come.

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.

 

[southernlady]

Welcome @Diana S.
As far as posting links, that will fix itself once you get past 10 posts and 24 hours. We restrict brand new members to avoid spammers posting malware links.

With Diana and Larra fighting for you, you are in good hands.

I have GERD but my need for NSAIDS far outweighed that. I can handle taking a daily PPI over never taking an NSAID again.

 

[Larra]

Hi again! I'm so glad you have found your way here. @DianaCox is the other person I mentioned on the other website, so now you know both of us. Once you get into the private conversation, we can get started communicating via email, which will be much easier as far as sending documents back and forth.

I agree about not worrying about pissing off the surgeon, but also will point out that it isn't necessary to piss him off. Once you get the testing and all done, you can send a very polite email requesting the DS. You'll get a denial, but once you have the denial you can schedule a consult with Dr. Rabkin so that he can prepare a LOMN (letter of medical necessity) to support your appeal. You will then have to go through Kaiser's internal appeals, which will result in a final denial, and then do an external appeal through the DMHC. Diana is better than I am at understanding insurance policies, but hopefully you do have external appeals rights because that's what it's going to take.

Meanwhile, keep in reading and learn all you can. You've already done a great job with your research, but there's always more to learn. Plus, we have a wonderful group of people here.

 

[JuliaDS]

Hello! I had a VSG in 2005 and went from 342 to 215. Over the years my weight has been creeping back up and then I became pregnant. I had my little one and have been maintaining a weight of 285 for the last year or so. Talked to my Kaiser PCP about a referral to the Bariatric Center, and had my appointment on Dec 1st. Bariatric surgeon approved me for a revision to RNY (specifically to treat GERD) but I don't like what I've read of RNYs. I'm pushing for DS more so because of the long term success and also because natural structures are left in place (the pyloric valve) which the RNY completely bypasses, favoring a hole punched directly into the stomach wall.

Scheduled for a fluoroscopy, blood work, and a mandatory nutrition class, as well as losing 10 pounds. After that a psych eval and schedule a date for surgery. Somewhere in there I need to make my plea for the DS without pissing off my surgeon. But I have something of a game plan for that too.

For the record, I have NorCal Kaiser through CalPERS. That seems to have made a HUGE difference in the initial stages here.

Hi and welcome @Diana S. You'll find a wealth of quality information and genuine support here. Looking forward to following your journey!