Hello!

[JRo]

You do understand that the 5 day pouch test is a made up diet to fool RNY'ers?

One of the RNY'ers over on anOtHer forum made it up and capitalized on it financially.

I did not know that, thanks for the info! It seemed like the exact type of plan my surgeon had me follow after the VSG but condensed for just a week, and it seemed like more of a cleanse for a restart than anything and I was desperate to kick start some type of loss, which obviously didn't happen. I suppose in some ways it was good it wasn't successful as it led me to finally research revision and led me here.

 

[DianaCox]

"Although when speaking with his office (who were extremely friendly btw), they had mentioned that when he read my submitted inquiry he was stating possibly revising to the RNY instead of the DS"

Warning Will Robinson! When I interviewed both Rabkin and Jossart on the same day 12.5 years ago, Jossart told me that with my insurance, the RNY wold be "good enough" for me - I walked out and didn't look back.

If your insurance is fully funded and delivered in CA, you will almost CERTAINLY win on appeal with the DMHC, if it is done right. Larra and I can help.

 

[Larra]

@southernlady I have long wondered where that idiotic 5 day pouch test came from. It has never made any sense to me and while I suppose there must be someone out there somewhere who benefited by trying it, I have yet to encounter that person. Now I know.

and @JRo this is the type of experience I worry about when you meet up with Dr. Jossart. He may be a fine surgeon (I have no idea but have never heard otherwise) but it will almost certainly be easier for him and/or his staff to steer you towards RNY than to help fight insurance for the DS, and to perform a surgery that in theory at least is quicker and easier. You know what you need, don't let anyone scare you away from it.

 

[southernlady]

I have long wondered where that idiotic 5 day pouch test came from.

Yeah, MsBatt is friends with the lady who dreamed it up. They've laughed about it for years.

 

[JRo]

"Although when speaking with his office (who were extremely friendly btw), they had mentioned that when he read my submitted inquiry he was stating possibly revising to the RNY instead of the DS"

Warning Will Robinson! When I interviewed both Rabkin and Jossart on the same day 12.5 years ago, Jossart told me that with my insurance, the RNY wold be "good enough" for me - I walked out and didn't look back.

If your insurance is fully funded and delivered in CA, you will almost CERTAINLY win on appeal with the DMHC, if it is done right. Larra and I can help.

Thank you, you make an excellent call out! When the office made that side statement when scheduling my consult, my response was no RNY, to which she said I can discuss with him directly. I am not having an RNY as a revision. I realize my BMI is lower, but I feel I have a valid reason for the DS and it's not up for negotiation. (On a side note, my mom had GB in 1991 and due to surgical complications, she died 5 months later. It's not the reason I'm not for the RNY, things are extremely different since then, and my situation is entirely different, but I am also acutely aware of fighting for what I believe in health wise and won't settle.)

I have been in contact with Rabkins office and they are aware of my hurdles and have been great with advice and support. At this point, since Jossart is listed as a DS surgeon, I have to pursue the consultation with him. If it is confirmed he won't do the DS, and only supports the RNY, then the appeal is much easier since, insurance aside, there is then only one surgeon in my area that can perform this complicated revision (Rabkin). The next stop will then be the DMHC. If that is where I end up, I will without hesitation reach out to you @DianaCox and @Larra and I am extremely grateful for your expertise in that area. Thank you in advance!

Anything worth having is worth fighting for!!

 

[JRo]

One question I have for all of you, although based on my research I think I have the answer, have you ever heard of Dr Coirin in Modesto performing the DS? He was my band and VSG surgeon and when I went for my follow up in May his PA was the one who advised me of the DS since the VSG clearly wasn't successful. However, I was not able to locate Dr Coirin on any site as a vetted or experienced DS surgeon. When I asked the PA how many he had done, he said quite a few, I said well a number, ballpark, he responded with not sure. Red flag....for sure. This is what led me to my referral request to Dr Rabkin (which btw, my Sutter PCP authorized the referral, BSC was the one who denied it due to the out of network issue).

However, I realize my limited exposure to this, so maybe I'm wrong about Coirin. Any feedback or info you all have that I'm unaware of?

Thanks in advance!!

 

[Charris]

Good luck you have the best 2 people to help you with your situation.

 

[southernlady]

One question I have for all of you, although based on my research I think I have the answer, have you ever heard of Dr Coirin in Modesto performing the DS? He was my band and VSG surgeon and when I went for my follow up in May his PA was the one who advised me of the DS since the VSG clearly wasn't successful. However, I was not able to locate Dr Coirin on any site as a vetted or experienced DS surgeon. When I asked the PA how many he had done, he said quite a few, I said well a number, ballpark, he responded with not sure. Red flag....for sure. This is what led me to my referral request to Dr Rabkin (which btw, my Sutter PCP authorized the referral, BSC was the one who denied it due to the out of network issue).

However, I realize my limited exposure to this, so maybe I'm wrong about Coirin. Any feedback or info you all have that I'm unaware of?

Thanks in advance!!

Coirin is not a name I have heard as a DS surgeon, even as a virgin operation. See if you can actually get solid numbers. Also ask how long he's done them and who he proctored with to learn the surgery. Also ask how he measures the common channel and how long it is "typically". That will give you a clue as to the DS or the SADI/LoopDS/SIPS.

 

[Larra]

@JRo I live in your general area, have definitely heard of Dr. Coirin, and have never, ever heard of him doing a DS, let alone a revision of some other bariatric surgery to a DS. And I've been around the DS community for about 10 years now. I'm not saying he's never done one, I have no way of knowing that, but I have not once encountered a DS patient of his anywhere, and I've seen plenty of his patients on other websites with other operations. I personally would not even consider him for a virgin DS. He may be a fine surgeon, but he is not a DS surgeon.

 

[SJB41976]

@JRo yes, I am considering revising to the DS. I'm thankful that 5 years ago I didn't have RNY as planned and instead a doctor talked about DS and the sleeve. From there I went for the sleeve, cause, you know....you think it will be enough. I also knew I could always revise to a DS since the sleeve was the first part. But honestly, going in, I had full belief that the VSG was enough. *sigh*

The person who dreamed it up might be laughing, but honestly, it is a good way to "start over". I've done it when I had the band. If you have been over-stuffing yourself it helps you feel fuller on less when you start back to eating real food. However, I have done that on my own with the sleeve.

 

[JRo]

@JRo yes, I am considering revising to the DS. I'm thankful that 5 years ago I didn't have RNY as planned and instead a doctor talked about DS and the sleeve. From there I went for the sleeve, cause, you know....you think it will be enough. I also knew I could always revise to a DS since the sleeve was the first part. But honestly, going in, I had full belief that the VSG was enough. *sigh*

The person who dreamed it up might be laughing, but honestly, it is a good way to "start over". I've done it when I had the band. If you have been over-stuffing yourself it helps you feel fuller on less when you start back to eating real food. However, I have done that on my own with the sleeve.

I share that sigh with you! I was so prepared and ready for the VSG to be enough and honestly, I was pretty proud of myself for how committed I was mind and body, that for it to be ultimately unsuccessful, was extremely disheartening. Out of frustration, I felt so defeated for awhile, but learning about the DS has given me a bit of hope. I am fully accepting and aware of the WLS being a tool, I just don't think it's too much to ask for that tool to actually do its part and work!

What's your next step towards the DS, still considering options or dealing with some hurdles?

 

[JRo]

@JRo I live in your general area, have definitely heard of Dr. Coirin, and have never, ever heard of him doing a DS, let alone a revision of some other bariatric surgery to a DS. And I've been around the DS community for about 10 years now. I'm not saying he's never done one, I have no way of knowing that, but I have not once encountered a DS patient of his anywhere, and I've seen plenty of his patients on other websites with other operations. I personally would not even consider him for a virgin DS. He may be a fine surgeon, but he is not a DS surgeon.

Thank you so much for confirming what I had felt to be true as well!! His PA seemed to off the cuff refer towards the SADI and a lot of air quotes were used and I was instantly feeling a large NOPE wall building.

On a side note, since I know you and Diana are so well versed and helpful on the insurance hurdle side of it, what do you think about submitting the DMHC appeal for the second opinion consultation with Dr Rabkin this early on. I am somewhat preparing for Jossart pushing the RNY and declining the DS, and the RNY is just not an option for me. I have the authorization from my Sutter PCP for the out of network to Rabkin, it was BSC that declined to pay for the consultation due to the network issue. With working at BSC (albeit in an entirely and unrelated department) I'm aware of the out of network regulation rule (CA Code Regs DMHC title 28, 1300.67.2.2(c)(7)(B)) I'm just wondering if it's too soon to start the appeal with DMHC since Jossart MAY be an option (although I think we all know it's not highly likely). Even though the appeal this early on would just be for the consultation, I'm wondering if I have to wait to speak with Jossart first to rule him out completely. Btw, I simply just self referred myself to Jossart since he is also part of Sutter IPA.

I may be too anxious and just need to wait until after I meet with Jossart, but was just wondering if starting the ball is possibly a good jumpstart.

Can you tell I'm hungry for the next step!! (pun intended lol)

 

[SJB41976]

I share that sigh with you! I was so prepared and ready for the VSG to be enough and honestly, I was pretty proud of myself for how committed I was mind and body, that for it to be ultimately unsuccessful, was extremely disheartening. Out of frustration, I felt so defeated for awhile, but learning about the DS has given me a bit of hope. I am fully accepting and aware of the WLS being a tool, I just don't think it's too much to ask for that tool to actually do its part and work!

What's your next step towards the DS, still considering options or dealing with some hurdles?

still considering options. I am self-pay, so I don't have to deal with insurance. I just want to make sure I want to do this and I am committed to everything it entails. I am tempted to wait and see what happens with the Sadi-loop but I've been down that road before with going with a procedure with no long term data...not doing that again.

 

[Larra]

My guess, based on past experience, is that you will need to confirm that Dr. Jossart is not a DS option before you can appeal to go out of network. We've seen people referred by their insurers to surgeons far less likely than Jossart to do a DS, and the DMHC has insisted that the in network option be confirmed as truly not available. At least Jossart has done the DS in the past, we know that much, so at this point we really don't know what he will be willing to offer you.

 

[DianaCox]

Basically, you have to exhaust your in-network options and appeals before you appeal to the DMHC.