Hello. I'm scheduled for RNY surgery on 7/30/18. I thought I wanted DS, and my surgeon does perform DS surgery, but he's worried about insurance coverage so won't do a DS unless I pay for the surgery upfront (and hope to get refunded later).

I'm confused as to whether I should seek another practice to perform DS, or just go ahead with the RNY.

I'm sure I can make RNY work for me, I'm about 40 BMI, and can lose weight pretty easily when I put my mind to it. It's just keeping it off that's the problem.

-Shane

Yes, you should find a different bariatric group to work with as your surgeon’s request to pay up front sounds suspicious and is just not common or standard. Don’t ignore red flags!! I wouldn’t use this surgeon for the RNY either.

For many, the DS (not SIPS/SADI) is the BEST surgery for long term weight loss maintenance and comorbidities resolution. Just make sure you select a DS surgeon that does the traditional standard of care, ideally Hess method, and has lots of years experience doing the surgery.

I don't think it's that uncommon for an insurance company not to cover the DS. Mine wouldn't - just RNY or VSG.

I can also see why the surgeon would want the money upfront if he does a DS - because if insurance doesn't cover it, and you don't pay him after he's already done the surgery, then he's screwed. I have plastic surgery coming up (self-pay) and I have to pay in advance. I don't think that's all that uncommon...

21 hours ago, _Shane_ said:

Hello. I'm scheduled for RNY surgery on 7/30/18. I thought I wanted DS, and my surgeon does perform DS surgery, but he's worried about insurance coverage so won't do a DS unless I pay for the surgery upfront (and hope to get refunded later).

I'm confused as to whether I should seek another practice to perform DS, or just go ahead with the RNY.

I'm sure I can make RNY work for me, I'm about 40 BMI, and can lose weight pretty easily when I put my mind to it. It's just keeping it off that's the problem.

-Shane

You can call your insurance and speak with them about if they would cover it or not, sure it'll need to be reviewed, but they can tell you up front if it's even possible. This will give you all the information you need to decide, but I agree, any doctor/surgeon requesting up front payment... very sketchy.

I happened to talked to the "BRS" nurse today. I think Bariatric Resource Services with my insurance company. I did ask her, and she told me what I already knew, that Lap DS surgery is covered and there is a code for it.

I have an appt. on Wed. with my surgeon. I'm going to do my best to persuade him that coverage won't be an issue (strange that I should have to do that). I'll see what my options are after that.

Edited July 6, 20188 yr by _Shane_