NY Lou

hi everyone. i think i originally posted this in the wrong forum, so ill post it here now. i know alot of insurance companies dont cover the sleeve. my insurance company doesnt appear to have the new 2010 code 43775 for the sleeve in their system, but they do cover the duodenal switch code 43845, which is basically the sleeve with a bypass. has anyone here gotten the sleeve done by getting approved for the ds and then only having their dr do the first part of the ds, which is only the sleeve? im curious if getting only the sleeve done this way would work to get the insurance company to pay for it or even if the dr would be willing to do only the first part of the ds? also, there is another bariatric open code 43843 that my insurance covers and that code specifically states "gastric restrictive procedure, without gastric bypass, other than vertical banded gastroplasty". has anyone been approved for a sleeve using this open code? any comments/replies would be appreciated. thanks in advance.

so i asked my dr where he learned to do the sleeve. he said he taught himself after watching his partner do them and by also watching videos of other dr's who had done them. i guess he really learned while being in the operating room with his partner (who is the head of the bariatrics unit). my dr has done over 300 rny's, 100's of lapbands and 6 sleeves. he says he only had 1 leak ever, and that was in an rny patient. i also asked him if there were any deaths and he said 1, but that was a person who was getting a revision of a revision. he seems very honest and straightforward in all his answers. his 6 sleeve patients are all doing well. my dr works on one of the best bariatric teams in new york, which is the st lukes hospital bariatric unit, which is also a bariatrics center of excellence and a leading research center for bariatric surgery. their team is headed by dr julio teixeira, who has done thousands of wls and teaches other dr's. dr teixeira is also well known to do surgeries that many other dr's wont touch because theyre being done on patients at high risk and/or with complications. apparently hes that good. i dont know how many sleeves he has done. my dr is the no. 2 on his team and his name is dr james mcginty. my insurance has dr mcginty on my plan, but no other dr from that hospital is on my insurance as different dr's there take different insurance companies. im confident in my dr and he was the best and most experienced from all the dr's that were accepted by my insurance. what do you think about him saying he was self taught? im not really worried about him only having done 6 sleeves (this was discussed in a prior thread), im just concerned about what is considered the normal way for a dr to learn how to do the sleeve? any replies would be appreciated. ps - i did ask my dr a ton of questions about the sleeve and his procedure, including bougie size, how far from the pyloric valve does he start, leak testing and so on, and he answered them all to my satisfaction. and ive researched the sleeve so throughly that i knew what answers i should of gotten. he really seems to know what he is doing and i am very confident in using him, but i guess him saying he was self taught is making me think. ps - i edited this ps in later. i just found out my dr operated on james gandolfini (tony soprano) back in 2008 (see link below). so if hes good enough for tony soprano, hes good enough for me http://showhype.com/story/news_james_gandolfini_hospitalized /

thanks to all for your replies, and please keep them coming. its such a great thing to be able to hear from so many different people in this forum. not to mention its so informative as well. on a side note, i just found out that james gandolfini (tony from the sopranos) used my dr for surgery (see link below) back in 2008. if hes good enough for tony soprano, hes good enough for me :thumbup: http://showhype.com/story/news_james_gandolfini_hospitalized /

so i completed everything and went to my dr for the final vist on wed june 30 (just 2 days ago) and i thought that was the last visit and he was going to submit everything to the insurance co. but my dr said that the abdominal ultrasound showed my liver was very big and also, my blood sugar level was elevated. he also said i had a vitamin d and vitamin b1 deficiency. he has put me on a diet with the nutritionist to lose 15 lbs in the next 4 weeks, as well as having me take vitamin d 50,000 once a week. i also got a vitamin b1 shot and i also have to go back to my primary care dr and have him check into my sugar levels and see if he feels i need to take some medication for it or just watch what im eating to lower it. so now i have to wait another 4 weeks and go back to my wls dr and hopefully then everything will be ok to proceed. losing the 15lbs will be a piece of cake as i am a professional dieter anyway, just venting as its frustrating to have this delay. i guess its the way this all works and obviously my dr wants me to have surgery in the best possible health i can be in. take care everyone and thanks in advance for any replies.

dr. james mcginty 6 im curious to see what results are out there. im only looking for the number of sleeves done prior to yours, although feel free to mention how many rny or lapbands were done by them also. my hopefully upcoming sleeve will be done by dr. james mcginty and he has only done 6 sleeves, although he has hundreds of rnys done. kindly list your surgeon and approximately how many sleeves they did before doing your sleeve. if you already see your doctor mentioned in this thread, theres no need to duplicate it. thank you, as im trying to see approximately how much sleeve experience various dr's had prior to doing yours.

hi everyone. i would like your opinion on this. im 5'9" 310 lbs. i have had many successes losing weight, as much as 87 lbs once, but ive always put it back on. while finishing all the steps to have my dr submit for approval for the sleeve to my insurance, im almost finished with the psych portion. ill be completely done with everything by mon june 28 and then i see my dr for the last visit on june 30 (less than a week away), and thats when he'll submit everything to the insurance for approval. the problem is this: the psychologist says to me that ive shown the ability to lose weight in the past. he feels that if i was disciplined enough to do this many times, then i could do it again with one simple difference. he feels that if i were to see a psychologist that specializes in eating behaviors, i could possibly lose weight again and not put it back on with the proper support. he says that the reason i put the weight back on is mental, and not physical. he would like me to try to lose weight one last time on my own with the help of a psychologist that specializes in eating behaviors before resorting to this permanent sleeve weight loss surgery. i dont think hes just trying to drum up business because he wouldnt be the psychologist i would be seeing, i would pick one from the ones offered by my insurance. i dont know if i should try this again on my own, or pursue the sleeve which in my eyes would be the tool that would help me with my ability to not put the weight back on again like i have in the past 20 years. hes also telling me that at 310 lbs im not as high in weight that alot of men are when they consider this surgery. hes still going to give me a letter to approve surgery if thats my decision, but hes just telling me his opinion after seeing me and talking to me for a few weeks. what do you guys think? hes confused me a bit and is making me think could he be right? right now i believe the sleeve would be the tool i need and it would definitely help me lose weight and keep it off. thanks in advance for any replies, its appreciated.

again thanks for all the replies. i have been researching the sleeve for quite a long time and ive decided that im going to continue forward and try to get the sleeve. im intelligent enough to know that ive been unsuccessful for 20 years in losing weight longterm, so the odds of being successful now are probably slim and none. my final meeting with my dr is on wed 6/30, in just 5 days and everything, including all tests and the psych are now complete. after that meeting he will submit to the insurance for approval. i guess i knew all along this was the right thing to do for me, but questions and concerns always linger in my mind. but if i wasnt planning on going through with this, i wouldnt of completed all the steps, tests, mandatory support group meetings, nutritionist meetings and the psych evaluation to be ready for insurance approval like i am now. i guess all of this second guessing is just a big step in me realizing i need help to get my weight under control. im tired of being tired. im tired of being overweight. im tired of telling myself im in pretty good shape for a 310 lb man, when in fact no man weighing 310 lbs is in good shape at all. thank you all again for your continued support. this forum is 100x better than any support group meeting ive attended. cant wait for the paperwork to be submitted for approval and i hope i get approved without having an insurance fight on my hands. take care everyone and as always, best of luck to all of you, whether pre-op or post-op.

i think the members of this forum have a better understanding of all of this than the psychologist does! and to globetrotter, you are 100 percent correct, the psychologist is tall and very thin. he has probably never experienced the struggle most of us here in this forum have been through. i think the answer is becoming clearer for me and the sleeve is the way to go. its only a matter of time before being 310 lbs catches up to me and my health starts going downhill. although i may not have the co-morbidities others at my weight may have, just carrying that weight around can't be doing my body any good. again, i appreciate all the replies from everyone. this forum is such a powerful support group for anyone considering or already having the sleeve surgery. thank you again so much to everyone, your input is priceless.

thanks again for everyones continued replies, theyre all appreciated and mean a great deal to me. to kabinkitty, i dont think the psych is trying to discourage me, i think hes just trying to make sure im ready for the surgery if its what i decide to do. it seems hes just putting all my options on the table and is basically asking me if i want to try on my own again, but this time with support from a psych who specializes in food behavior before trying the surgery. hes made it clear the final decision is up to me and will give me a letter of approval for the surgery because hes convinced ive done my research and know exactly what the sleeve entails, including the risks involved, as well as the aftercare necessary after the surgery to be successful. as far as 310lbs not being that high, i guess hes saying that because his experience with weight loss patients involved men who were much heavier than me. also, like you said about co-morbidities, im actually in pretty good health for someone weighing 310lbs (as crazy as that sounds!). im definitely leaning towards getting the sleeve as i kind of feel that if i was going to succeed on my own, i would of already in the last 20 years. again thanks to everyone who has chimed in, this forum and its members is a true blessing.

thanks mb20mom and mini-me for your replies. mini-me, the dr said he would give me the approval i need for surgery. he was just suggesting based on my history that he feels dealing with a psychologist that specializes in food behaviors might be the tool i need to keep the weight off when i lose it. in my heart i think the sleeve being a restrictive tool is my way of guaranteeing that when i lose weight, i would keep it off. its been a struggle to lose weight and then gain it all back so many times. at the age of 47 im definitely leaning towards getting the sleeve. i think the sleeve may be the best tool for me to succeed long term. i guess its kind of his job to play devils advocate and make sure ive tried everything before i have the surgery as he views the surgery as a last resort. but a big part of me feels after so many years of not keeping the weight off, this is a last resort. but not one as drastic as a bypass, which i would not consider now at all. i know the bottom line is i have to decide for myself whats best for me right now. its just nice to hear others opinions who have been through this struggle. thank you.

hi aloco53. your story definitely rings a bell with me as i too didnt get any surgery done although i was thisclose. like me, maybe it just wasnt your time back then and maybe now the sleeve is the right thing for you. good luck with whatever you decide to do. hopefully when it happens, it will be the right thing for us both. take care.

hi everyone! i have read so much in this forum and want to say thankyou to every single poster! ive learned so much and sincerely appreciate verticalsleevetalk.com. im a 47 year old male living in brooklyn, new york. i currently weigh 305 lbs and have been overweight all my life. ive been hovering around the 300-315 mark for about 10 years. before that i hoovered around 280-300 for the prior 10 years. my high weight was 323, which was in 2004. the most ive lost dieting and exercising was about 40lbs on a few occasions, but i always put it back on. in 2004 i decided to have wls and was going to have gastric bypass done. after being approved by my insurance, i went to the hospital and was put in scrubs for the operation. then i was told by the nurse that the doctor had a family emergency and had to leave the hospital immediately. so my surgery was rescheduled for 4 weeks later. during these 4 weeks i ate plenty and went on a "goodbye to food" tour! this tour took me to all my favorite buffets and i ate like it was my last meal, even though i knew i shouldnt be doing that. then i again went to the hosptial and was put in scrubs and before my surgery the doctor said he couldnt operate because my sugar level was unexpectedly through the roof. i begged him to go through with it, but he said he couldnt and i needed to lose some weight and not do what i did by gaining weight and eating everything before surgery. so it was again cancelled. now i was determined to lose weight before i went back in 6 weeks for the eventual operation. in those 6 weeks i ate perfectly and lost 30 lbs. the day came and i went in a 3rd time to the hospital. again i was put in scrubs and this time all the tests, including my sugar were normal. but the doctor was surprised that i was able to lose 30lbs in 6 weeks. he sat me down and said the operation was a serious one and if i was able to lose 30lbs in 6 weeks, maybe i should give losing weight on my own another try. he convinced me to not have the operation. so i actually went on to lose a total of 89lbs in 7 months and got my weight down to 234 and felt great. i was actually running on a treadmill for a few miles non-stop and was in the best shape of my life. a year later i was again at 310lbs. i never considered wls surgery again because i honestly in my heart didnt want the bypass portion done. and im thankful that even though i was in the operating room 3 different times, i never had the bypass done. later in life i researched the lapband as it became popular, but again i didnt want the band either due to all the complications of it. only a few months ago i discovered the option of the sleeve, and it seemed like exactly what ive been waiting for. a tool to limit my intake, with no bypass and nothing permanently inside of me that needed followup adjustments. so im now in the process of going through everything i need to do before my dr. submits for approval to my insurance. the only thing left is the psych evaluation, which im in the process of completing and ill have it done shortly. then i meet with my dr. again on june 30th for the final time and he will submit everything to hopefully get approved. so thats my story. its seems that bypass just wasnt for me. and ironically back in 2004 i was all for it. now today, i wouldnt do a bypass ever. im thankful it never got done and i believe it wasnt meant to be. especially being in the operatiing room in scrubs 3x! i do have one fear/question that ill post in a separate thread in the post op forum as i believe that is where it should go. again, thank you to everyone who has ever posted in this forum. you do not know how much it helps, even the people like me who only read and never posted before. best of luck to everyone on their journey.

hi everyone. i know alot of insurance companies dont cover the sleeve. my insurance company doesnt appear to have the new 2010 code 43775 for the sleeve in their system, but they do cover the duodenal switch code 43845, which is basically the sleeve with a bypass. has anyone here gotten the sleeve done by getting approved for the ds and then only having their dr do the first part of the ds, which is only the sleeve? im curious if getting only the sleeve done this way would work to get the insurance company to pay for it or even if the dr would be willing to do only the first part of the ds? also, there is another bariatric open code 43843 that my insurance covers and that code specifically states "gastric restrictive procedure, without gastric bypass, other than vertical banded gastroplasty". has anyone been approved for a sleeve using this open code? any comments/replies would be appreciated. thanks in advance.

ive read that many drs use a 32 frech size bougie when creating the sleeve. i also know that not much food can be held in that size stomach. i was considering asking for a larger size bougie to be used so that i can still lose weight, but i can also hold/eat a little more so that i can kind of eat a little bit of a more normal sized meal and not stand out that ive had some sort of surgery by only being able to eat a little, especially at social gatherings. am i overthinking this? is this just me stressing a bit over my fear of losing my ability to really enjoy a larger size meal like i do now? my thinking is that even if i use a larger size bougie, my stomach will still be much much smaller than it is now and ill still lose weight. i realize the weight loss might be a bit slower than if i used a smaller bougie, but i still should lose weight effectively, even if my new stomach stretches over time. then again, part of me feels im just feeling this way because of my fear over this whole sleeve thing. any opinions/comments? thanks in advance.

obviously a big fear regarding this surgery is getting a leak at the staple line. exactly when can someone post-op stop worrying about this? im guessing that a leak can only occur during the first few weeks until the stomach heals, but im not sure. or can a leak happen after this time period if someone doesnt eat properly? any replies would be appreciated. thank you.

thanks to everyone for their replies and input. my dr has not done any ds (which the first part is the sleeve). so his 6 sleeves done is all hes done. i definitely have had many conversations with him about the procedure and my concerns, and i am confident in his ability as a surgeon or i wouldnt of chosen him. of course i would of wished he had done more sleeves, but out of the insurance list i had to chose from (about 25 drs), only a handful had done sleeves at all. and as i stated, my dr had the most of anyone on that list with 6. i actually didnt chose him because of his 6 sleeves done, but i chose him because he seemed the most qualifed surgeon on the list out of the ones who had done sleeves with 100's of rny's and lapbands. and also he is working out of a well known ny hospital recognized for their excellence in bariatrics. the hospital, st lukes hospital in ny is also a major research center on bariatrics surgery too. i feel like im in good hands, and honestly, i couldnt afford to self pay right now, at least not in the states. so im kind of locked in to trying to find the best option that my insurance will cover. if i had to self pay, i would probably go to mexico to dr aceves as he seems to be very qualified as a surgeon and the price for going out of the u.s. makes a big difference. ill keep hoping for the best and hopefully it will all turn out ok. my first big step is meeting with my dr on june 30 (only 12 days away) and thats my final visit before he submits everything to the insurance. take care everyone and thanks again.

hi everyone. from the list of dr's that my fidelis insurance accepts, i chose the dr who had done the most sleeves, who also happened to be the dr with the most experience in bariatric surgery. that is dr. james mcginty and his number of sleeves is 6. the majority of drs on the list had done 0, and a few drs had done a few sleeves, with the dr i chose having done 6. hes done 100's of rny's and lapbands, but only 6 sleeves. hes had no problems or leaks with the 6 hes done. he also works out of a great well known hospital in ny, st. lukes hospital, with its bariatric team headed by another well known bariatric surgeon dr. julio teixeira. is this something i should be concerned about? obviously the more any dr does a procedure the better he will become at it and the more experiences he'll have with situations that may arise. but my choice comes down to choosing the best dr on my insurance's list or self-pay. obviously i would like my insurance to pay for it. this hospital also has a great pre-op and post-op team in place that really supports their patients well after the surgery. what do you guys think? thanks in advance as i sincerely appreciate all the good people who take the time to contribute here.

hi everyone. does anyone have any experience with this dr. or any dr at this hospital for a sleeve? thanks in advance for any comments.

whether good or bad, im curious if anyone has had any experience with trying to get the sleeve with fidelis. i know they approve rny and the lapband, but not the sleeve directly as they dont recognize the new 2010 code 43775. but they do have an open restrictive code 43843 that they have sometimes approved and im wondering if anyone has tried that with them for the sleeve. code 43843 specifically says "gastric restrictive procedure, without gastric bypass, other than vertical banded gastroplasty". they also approve code 43845 which is bioliopancratic bypass w/duodenal switch, which basically is the sleeve with a bypass. and im wondering if they approve that code can i only have the dr do the first half of that procedure (the sleeve) without the duodenal switch (the bypass). thanks in advance, its appreciated.

thanks to all who have replied. it definitely is comforting knowing there are so many people in these forums who are willing to speak openly about their own experiences. i definitely feel that it was fate for me to not get the bypass and end up discovering the sleeve. afterall, being in scrubs 3x and not getting the surgery done is probably unheard of. to goodlife: ive never heard of the restaurant peaches, but ill have to ask around and/or look it up and give it a try one day. thanks for the tip. have a great evening everyone!

thank you so much to all who have replied. it definitely makes me feel better hearing all your stories and gives me hope and makes me feel that everything will be ok. i sincerely appreciate every single reply and wish continued success to you all.

hi everyone. ive been reading this forum for a few months and just registered. if you want to know my story, click the link below as i posted it in the "tell your story" forum. http://verticalsleevetalk.com/tell-your-story/6537-i-operating-room-scrubs-3x-gastric-bypass-im-new-here-hi-everyone.html i have only 1 huge fear about the sleeve, or wls surgery in general. its missing out on being able to socially eat a full meal. ALL my family, friends and co-workers Celebrate everything by eating out. whether its a birthday, holiday, job promotion or just the weekend, it is always going out to eat. i know thats probably why im overweight, but my fear is missing out on this. its all i know and the only way everyone i know celebrates or goes out. without the ability to eat with them, i fear ill be a sort of outcast now, not wanting to be in that situation. how hard will it be to still go out, but really not eat and partake the way they all will? its sad to say everything revolves around food, but it honestly does. i fear pulling back and away from these events since i wont be able to eat like before, and unfortunately, these events are my family, friends and what makes up my life. has anyone gone through this and how have you coped with it? and as crazy as it sounds, my favorite food is seafood, specfically crablegs and shrimp. i almost feel like ill be missing them like im missing someone who died. is this crazy?? thanks in advance for any replies. have a great day!