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Everything posted by WOLVESFAN1

  1. I will be having my gastric sleeve converted to the RNY hopefully, in December. I was told by my provider that they never had to get the authorization up front with Medicare. She said they submitted the letter of medical necessity with the claim when they filed and they never had any problems. I believe that Medicare has guidelines you must follow in order for them to cover my procedure. The problem is I'm not overweight, but I'm being revised due to spontaneous reflux. Everything I eat the majority of it comes back up. I definitely have the medical necessity. In my doctor's notes he states that I am malnourished and not receiving the nutrients I need to sustain life. So, basically if I don't have the procedure I'm not going to live a lot longer. My BC/BS of AL will not cover it because I had the original procedure out of the country and didn't follow insurance guidelines that are typical for WLS. I had other insurance at the time I had the surgery. The surgery was done probably 10 years before I became effective with BC/BS of AL. I've contacted Medicare to see if they would cover and was told yes if medically necessary. Since the self pay is a lot, I want to feel warm and cozy on the idea of the surgery being covered by Medicare. Has anyone had the revision due to complications only and Medicare cover? Thanks!
  2. I had the surgery on a Friday and went back to my office job the following Monday. No problem, but my weight came back quickly. The same thing with the sleeve. I had it on a Thursday, flew back on Sunday and went to work on Monday. I must admit that was a killer long week. I should have taken more time of for the sleeve. I'm converting from the Sleeve to an RNY in December. When we fly there we're usually 12 hours with flights and layovers coming and going. I'm hoping I will hold up okay with that. I did when I had my hernia repair a few months ago.
  3. I was banded in 2005 and I had constant slime/gerd. Totally disgusting! I had the band removed later in 2005. I went to Mexico to one of the well known surgeons there and had the gastric sleeve. I lost over 100 lbs and I've kept it off. However, 2-3 years ago the gerd started and it has gotten gradually worst. Doctors in my local area refuse to treat me because I had the sleeve done in Mexico. I was able to get the Mayo Clinic to treatment. I had a large paroesoIphgeal hernia that was pushing a 1/3 of my stomach into my chest cavity. The hernia damaged my diaphragm, stomach and my esophagus. The surgeon corrected that earlier this year. He said my sleeve was larger than normal, but it was the size they did them in 2005. He also said it had angular shape to it. He thought everything should be fine. Well I get home and as I increase the different foods the gerd comes back bad. Another trip to Mayo and I now have spontaneous reflux. Anything I swallow most of it comes back up. The sleeve has developed some sort of pocket and basically the food is going into the pocket and once it gets full it has no where to go, but up. My surgeon wants me to convert to an RNY. My insurance is not going to cover it because I was a self pay and even though I didn't have the current company when I had my surgery they said I should have followed the protocol of the prior insurance carrier. Since I didn't do that they won't cover it. They even have one of my claims from a procedure that the Mayo clinic did earlier pended for medical records. I plan to pay that out of pocket because I don't want them to take back other monies they have paid out. Bottom line is I become eligible for Medicare in December and hope to have my RNY early December. Strictly for the gerd. I really can't afford to lose any more weight.

    Revision success

    Do you all go from Sleeve to an RNY. I will be doing that in December due to reflux. It is so good to know you all have had success. Is the eating a lot different than the Sleeve. I had my sleeve 12 years ago and lost 100 lbs. I've kept it off, but the reflux started 2 years ago and has gotten progressively worst. Congrats to all of you!

    ❤My Revision Story❤

    Congratulations on your successful revision! I'm in the situation that you were in I had the Lap Band in 2005 and due to throwing up, it was removed several months later. In 2006 I went to Mexico and had the Gastric Sleeve. I have lost over 100 pounds and I've kept it off. My problem started almost 2 years ago. I started throwing up undigested food. I went to a US surgeon and was told I had a large hernia and it was causing a large portion of my stomach to push into my chest cavity. Long story short, the hernia was repaired and the doctor thought that would correct the reflux. Well it hasn't. After having more test ran he has determined that I now have spontaneous reflux. I'm actually dropping more weight due to the spontaneous reflux. My doctor said that usually if you have problems throwing up with the lap band, you will with the sleeve. He said my sleeve has some angulation. He has recommended the conversion to an RNY in order to sustain life. Unfortunately, my insurance is not wanting to cover. I will be eligible for Medicare in December and will limp along until then. Medicare will cover the revision. Thanks for your updates on your revision. I'm extremely nervous about having the RNY, but have no choice. BTW, you look awesome in your pictures. Keep up the great work!