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lolarose13

Gastric Sleeve Patients
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Posts posted by lolarose13

  1. Posted

    Yeah. I got my revision to bypass last week. So far, this has been easier than the sleeve, and I’m just exhausted, but nothing hurts. I had horrible GERD, so they corrected a large hernia and cut my prior sleeve even more, to make it look good (it was enlarged). After all, the surgeon said everything looked great, and I felt ok. I’m hungry, but I think this is more mental than anything. I need to lose around 50 pounds to meet my goal. I was around 20 pounds short with the sleeve, but I could not do it.

    Tomo reacted to this

  3. Posted

    On 08/19/2022 at 19:27, Dogmom68 said:


    I’m so sorry your insurance denied your surgery. If your doctor will submit for a hiatal hernia repair then I’m sure you would be approved. That’s what mine did and I found out yesterday that I’m approved for the repair. I do, however, have to pay out of pocket for the bypass portion. I’m not sure how large my hernia is but I think your insurance should approve you regardless of the size. Talk to the surgery scheduler at your doctors office on Monday and see if she can submit for the hernia repair. My out of pocket for the bypass was $2600 which we went ahead and paid. I’m keeping my fingers crossed for you and hope you’ll get your approval!! Keep us posted! 💕

    So I appealed to Aetna, and they still said no. Thankfully my husband changed jobs, so I moved to his insurance, and now I have Anthem! I looked at their guidelines, which seem much more straightforward than Aetna's. My doctor will submit everything again today.

    Unfortunately, my doctor only will perform the surgery if they approve me for the bypass and not the hernia repair, so I’m hoping this works! Wish me luck! 🍀 I’m so tired of going through the hoops, and I’m feeling horrible, so I need this so bad 😭

    Tomo reacted to this

  4. Posted

    05/25/2022 02:45 PM, Gonzo23 said:

    Anyone get approved from Anthem Blue choice open access PPO?

    I just switched insurance to Anthem. I got denied by Aetna because they wanted me to do this stupid ph 24hr test. I appealed, but they didn’t care. So I was able to switch since my husband was moving jobs. how was your experience with them? mine is a revision to bypass.

  5. Posted

    On 08/20/2022 at 16:27, I♡BypassedMyPhatAss♡ said:






    You can't fake GERD. I mean there's a number of tests that can detect it via imaging.




    I developed GERD about six years after surgery. I had all of the tests that proved it so getting approved for revision was easy.




    I lived with GERD long enough on a double dose of Protonix to develop a kidney stone from overuse of PPI's... who would fake all of that? Not me.


    Hi, what test did you have to prove it? I just got a denial for revision because they want me to do a pH 24hr monitoring test to probe my GERD. I appealed because my GERD has been documented, and I have an EGD done showing that I have a large symptomatic Hiatal hernia, but I guess they want this test to prove it...I’m very frustrated.

  7. Posted · Edited by lolarose13

    14 hours ago, Daja said:

    There are a couple different kinds of pH monitoring. Neither of them are pleasant, quite frankly. One of the tests involves that the tube ( an ng tube) be placed down your esophagus into your stomach via your nose and stay there for 24 hours. It monitors the acid that you have and your doctor will read the monitor afterwards; you’ll eat with it, shower with it, everything. The other PH monitoring test is usually done in the hospital and they also place an ng tube into your stomach via your nose and they spray some salt Water into the back of your mouth and you are asked to swallow and then not swallow and it measures how strong or weak the lower esophageal juncture is. That is the test that I had done. For me, The machine also broke in the middle of the test. When I asked the doctor if I had to repeat it and he said no, I was so happy I almost cried, as it was one of the most horrible tests I’ve ever experienced in my life. The test they choose depends on insurance company requirements as well as what they think is the cause of your reflux is. Just excess acid or is there a possibility of an anatomical issue. For me it was both. And a paraesophageal hernia that was strangulating my stomach though that didn’t show up on any of the tests they did in advance, it was like surprise lol!

    Thank you! this is incredibly useful information. My doctor suggested filing an appeal just for the unnecesary burden of going through this test since the symptoms have been documented for years. Did you have to stop your meds before the procedure? I cannot even imagine trying to do this if I can barely make it without them; I want to cry!

  8. Posted

    Hi guys,

    So Aetna denied surgery conversion to bypass because they need "extra" proof of my GERD. They recently changed their rules and are asking for a PH Probe 24hr monitoring with abnormal results. I talked to my GI, and he told me that in order to do this test, I need to temporarily stop using medications that suppress stomach acid for about a week before the test; WHAT!? I can barely leave without them (I take a double dose, morning and night, and I am still waking up choaking most of the time, I have horrible reflux, etc.) and they will make me go through this just to prove that I have horrible GERD?

    I talked to my doctor's team, and they believe I should file an appeal just to explain this unnecessary burden and suffering, as this is the first time an insurance company required this test. Does anyone have an appeal letter as an example that I can use to start this process? I'm just so upset about this is ridiculous.

    Thanks!

  9. Posted

    On 08/02/2022 at 16:09, Daja said:



    I went with a different surgeon due to insurance issues. Had major GERD issues with Barrett’s esophagus, my GI had me maxed out on PPI’s and did PH monitoring, EGD, and Barium’s swallow tests. All of this is usually required by insurance companies before they will pay for the revision. Sometimes GERD is caused by a change in the anatomy of the original sleeve (which was not the case for me) my Dr told me if that is the case they can use a ballon to change it to what it should be or try to resleeve rather than a revision to RNY. It’s definitely worth a consult before such a major surgery. Wishing you all the best…


    Can you tell me more about the PH monitoring? I don’t know what to expect if we go ahead with this. I thought finding a hernia would be enough, but my doctor submitted me a GERD revision.

  10. Posted

    On 08/03/2022 at 15:13, jenuinelygenuinely said:



    I went with a totally different hospital/program after having a bad nutritionist. Like @Daja I had to get an upper endoscopy and a barium swallow test done which was required. My first consult the doctor told me a revision would be best if I had severe GERD but they weren't going to approve me for surgery without doing tests...LOL




    During my tests they found the reason for my GERD and deemed it medically necessary. The surgeon did tell me if they found a HERNIA he would've performed SAD-IS procedure or a DS.


    I will have to talk to my surgeon about this. My insurance just denied my revision because they wanted to prove my GERD with a 24hr PH monitoring test! I already had an endoscopy and the doctor found a large hernia, but now they want me to prove my GERD with a super expensive/extensive test? I’m upset that my doctor wants to go ahead with this.

    jenuinelygenuinely reacted to this

  11. Posted

    On 08/07/2022 at 02:57, Dogmom68 said:


    Hey! I have BCBS. I was fortunate when I called my insurance company to get a representative who had just recently had gastric bypass surgery so she was incredibly helpful! She said it was not uncommon to be denied initially and that my doctor could either do a peer-to-peer call with one of their doctors or my doctors office could order some other tests to document the hiatal hernia further. Once that was done they could re-file and most likely I would be approved. So I haven’t given up hope yet! 😁

    I got denied yesterday by Aetna. They changed their rules, and now they want 24 abnormal PH reflux monitoring to prove my “GERD.” Gosh, I hope my doctor tells them about the hernia, and we can get approved because of that or get that surgery + the bypass. How big was your hernia? Mine is 4cm, which is big (I imagine) since I’m a very small person. Wish me luck!

  12. Posted

    On 08/01/2022 at 23:49, Dogmom68 said:

    Well, I’m pretty disheartened. My surgery was pushed from 8/8 to 8/29 to give my doctor’s office time to resubmit paperwork for an authorization for a hiatal hernia repair. My insurance didn’t approve the bypass revision so I may have to pay that portion of the surgery myself. I had already started my pre-op liquid diet so now that’s on hold for a few more weeks. I was so ready to have my surgery next Monday and now I just feel disappointed and frustrated. If I could afford to pay for the entire surgery, I would just to avoid the hoops I’m having to jump through to get this approved. I could use some words of encouragement right about now. 😢

    Hi! do you mind telling me what your insurance is? I have Aetna, and I have a feeling this is going to happen with me since I have GERD and EGD only showed a Hiatal hernia.

  13. Posted

    On 02/14/2022 at 12:59, mae7365 said:



    I have Aetna, and my revision due to GERD and esophagitis was covered and I was not required to meet any of the pre-surgical bariatric parameters like diet, psych eval etc. I also had hernia repair, but the primary reason for the revision was the GERD and esophagus damage. I did have to have all the medical tests that proved I had GERD and esophagitis. The RNY revision was medically necessary and insurance approved and covered the surgery.




    I have lost 60 pounds since the revision surgery which has been a very pleasant side effect of the revision. Being able to sleep without acid in my mouth has been wonderful!


    I’m so glad this is working for you. I also have Aetna. I have GERD, but the EGD only showed a hietal hernia. I looked at the guidelines and they changed the requirements if get a revision to bypass only for GERD. I’m hoping the hernia repair will be enough to get approval. anyone knows more about this?

  14. Posted

    On 04/21/2022 at 18:53, nidvia said:


    You totally right, I had an appointment with the dietitian today and she said that everything I’m doing to avoid the reflux is good and that the surgery will definitely help. Now I have to wait until May 31 to see the surgeon and see what he says.

    hey! how was your surgery, how are you feeling? I’m on the same boat trying to get the surgery. Same thing, GERD after sleeve, EGD showed an hernia and I want to get revision to bypass. My BMI is 31 and my fear is that my insurance won’t cover it 😢

  16. Posted

    Anyone here got the revision from sleeve to bypass with a lower BMI? Long story short, I got a revision from band to sleeve on 2016, reached my goal weight, and started to have lots of reflux and life and my current BMI is now 31. I started the process to get a revision, and the EDG only showed a 4cm hietal hernia but nothing related to esophagitis. I have to go back to the doctor next week, but I’m fearful my insurance will deny me because they would need more proof of my GERD. I read the guidelines for Aetna, and it says esophagitis 😭

  18. Posted

    Hi, tlemieux. I used to live in Mesa too! I had my sleeve surgery almost 3 years ago with Dr. Suarez and since then I moved to FL and my old habits are creeping in. Right now I’m 15lb from my goal. I was only 5 pounds from 130 but I started gaining weight just like you. The struggle is real and I love getting a reminder that is up to me to make this change and finally hit my goal. Let’s finish what we started!

    ProudGrammy reacted to this

  19. Posted

    On 08/30/2018 at 10:16, MoDimples said:



    Hello, I am a new member. I'm about 3 months post op. My heaviest was 320lbs. About 2 weeks ago, I was 222lbs. (so close to the 100lbs down club) I wanted to be 219/220 by the end of Aug. Instead, I've gained 7lbs. I haven't been eating a lot and I work out practically every day for no less than 3hrs. The problem is that I got cocky. I started eating high calorie items I know I shouldn't have. Now, I'm so depressed about it and afraid that I won't meet my end of year goal of 199 or less. You guys have given some good advice here. Hopefully, I can get back on track. Pray for me please.


    Praying! You can do this sister!

  23. Posted

    My surgery is on Thursday. been so busy getting everything at home/work in order. Had my preop appointment today at St Luke's. Everyone was great but wasn't the most fun I have ever had. Well it's a small price to pay for a new life. So

    So Dr Juarez is you doc. so when do you start the liquid diet? are you going to be drinking Bariatric Advantage?

    Yay!!! Only a couple of days to have your sleeve! I'm 10 weeks post-op. My pre-op diet was only a week because my BMI was 35 with several commorbities. I got the BA shake, coffee flavor. It was really good but after surgery I couldn't drink it anymore, so I did muscle milk or premier Protein.

    Sent from my iPhone using the BariatricPal App

  24. Posted

    I'm in surprise as I'm getting sleeved in sept at st. Luke's through Wliaz

    Sent from my iPad using the BariatricPal App

    Az

    Sent from my iPad using the BariatricPal App

    Im being sleeved Aug 25 2016 at st Luke's thru Bridges and I live in Peoria

    Hi! I was sleeved June 6th, 2016. I went through the Bridges program at St. Luke's Medical Center and Dr. Juarez was my surgeon. Best experience ever! I'm feeling great :)

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