New Here :D

[4handstohold]

How did he think he could get away with this?
Yeah, I agree, how can I trust him at all?

 

[Larra]

He gets away with it because the overwhelming majority of patients don't know the difference. The people we reach here are a tiny fraction of those having bariatric surgery (about 200,000/year in the USA alone) and I would guess a similarly tiny fraction of his practice.
At some point, my guess is that the insurance companies will catch on to the fact that this operation is not the same as the DS and is not what is described in the cpt code most surgeons seem to be using (note - I don't know what code Dr. Cottam is using). We have also seen what I call creative coding reported by some patients, such as "sleeve gastrectomy with intestinal anastomosis". Sounds very medical, but no anastomosis of any kind is needed for a sleeve gastrectomy, and any anastomosis implies that some part of the bowel has either been removed or reconfigured in some way and then a reconnection was needed. So a smart insurance company person would wonder about this, but apparently a lot of these approvals come from people with little or no medical knowledge. We certainly see that with denials, why not with approvals?

So, if you do decide to proceed with Dr. Cottam, ask him very direct, specific questions about what surgery he's doing, and on your consent form, write in that you give permission only for the traditional, standard of care DS and you specifically refuse permission for SIPS/loop DS, SADI - unless you decide that this is what you want. My goal is not to pick your surgery for you, just to make sure you are well informed and that you get the operation of your choice.

 

[newanatomy]

Dr. Simper is also in Utah. He does not do SIPS. Maybe, his office takes your insurance. He is an experienced RNY to DS revision surgeon.

http://www.utahbariatrics.com/about/why-choose-rmap/

Dr. McKinlay is also a vetted DS surgeon although I don't think he does RNY revision.

 

[4handstohold]

Welcome @4handstohold! You've come to the right place. Lot's of quality information and support here.
I'll add to those urging you to accept help from the wonderful folks here and continue to investigate all options to get yourself a DS. I too have seen many 'fail' with RNY and sleeve - they loose initially, sometimes a substantial amount, but always seem to gain it all back and then some... Good luck!
Gorgeous children, by the way!

Thank you!

 

[4handstohold]

Dr. Simper is also in Utah. He does not do SIPS. Maybe, his office takes your insurance. He is an experienced RNY to DS revision surgeon.
Dr. McKinlay is also a vetted DS surgeon although I don't think he does RNY revision.

Ok, tks for the info, I am looking to see if Dr McKinly accepts my insurance.

 

[4handstohold]

He gets away with it because the overwhelming majority of patients don't know the difference. The people we reach here are a tiny fraction of those having bariatric surgery (about 200,000/year in the USA alone) and I would guess a similarly tiny fraction of his practice.
At some point, my guess is that the insurance companies will catch on to the fact that this operation is not the same as the DS and is not what is described in the cpt code most surgeons seem to be using (note - I don't know what code Dr. Cottam is using). We have also seen what I call creative coding reported by some patients, such as "sleeve gastrectomy with intestinal anastomosis". Sounds very medical, but no anastomosis of any kind is needed for a sleeve gastrectomy, and any anastomosis implies that some part of the bowel has either been removed or reconfigured in some way and then a reconnection was needed. So a smart insurance company person would wonder about this, but apparently a lot of these approvals come from people with little or no medical knowledge. We certainly see that with denials, why not with approvals?

So, if you do decide to proceed with Dr. Cottam, ask him very direct, specific questions about what surgery he's doing, and on your consent form, write in that you give permission only for the traditional, standard of care DS and you specifically refuse permission for SIPS/loop DS, SADI - unless you decide that this is what you want. My goal is not to pick your surgery for you, just to make sure you are well informed and that you get the operation of your choice.

Thanks for your info- I don't think I'll be seeing Dr Cottam again.
I'll try to find someone else

 

[4handstohold]

Welcome @4handstohold
Regarding Dr. Cottam: http://bariatricfacts.org/threads/dr-daniel-cottam-bmi-of-utah.2661/

Got it! Thanks!

 

[4handstohold]

About half those undergoing RNY will gain weight back after a couple of years. In another post, @southernlady and others talk about fighting insurance and why the RNY is not a good option... the thread is at

EDIT: I found an even better link with scientific evidence of weight regain after RNY, which was also posted by @southernlady[/USER

Ok tks!

 

[4handstohold]

There are people here (me for one) who help people fight their insurance for the DS, for free.

Wonderful!

 

[4handstohold]

Hi and welcome!

You need to get a copy of your EOC (evidence of coverage) and see what is and isn't covered, or perhaps there are circumstances in which the DS would be covered, or you may have appeals rights. Without knowing all the details of your policy, there is no way to know. Your EOC is a lengthy document, maybe 60 - 100 pages, NOT a little summary of benefits. Do not take the word of some low paid agent who answers questions when you phone in. They don't care about your welfare, they are just putting in their hours.

If you can get the DS, you also need a different surgeon. Dr. Cottam used to do the DS but has not gone to only doing the loop DS, aka SADI and aka SIPS (as he likes to call it). This operation is not the same as the DS, long term results are unknown, and there is no insurance code for it. Most people in the field consider it to be experimental. Some surgeons are using the DS code for insurance purposes, which may or may not be accepted. we know of at least one person who had pre-approval and after her surgery the insurance company withdrew coverage because she didn't really have a DS, and she was sent a large bill. There are other surgeons using creative coding. Again, this may or may not fly when the insurer figures it out.

Lastly, you asked about failure rate with gastric bypass. The statistics are well known as this is a well established operation. The failure rate is about 30%, with "failure" being defined, usually, as losing less than 50% of your excess weight. In other words, if you lose 51% or more, you are counted as a success. Personally, I would not have been happy with, let's say, losing just 50 - 60 % of my excess weight, which is a frequent results. Weight regain is a major problem. You will also never be able to take NSAIDs again as they are contraindicated with gastric bypass for life.

I think you need to be a bit more research. Find out what you are and are not able to get with your insurance, and don't make any hasty decisions now that you've decided to take the plunge.

Great! I'll find a new Surgeon and find out what my benifits are. Thanks!

 

[4handstohold]

And Larra, you're right about that - his "Informed Consent" form is grossly misleading. It talks about the DS and only in one place does he note that he means the LOOP DS

I think he's a snake in the grass and an arrogant prick (in my opinion, of course). If you can get him to SWEAR he means a conventional, two-anastomosis DS, and under no circumstances will you accept his experimental (yes, he's doing a clinical trial on it: SIPS/SADI/LoopDS, or you will sue him.

That's ok, I'm going to find someone else. I have noticed that he does come off pretty arrogant by the way