I had a sleeve done in 2015, did well, lost 92 lbs, gained back about 25 lbs now, during the past year as I cannot get my heartburn/Gerd under control.

I was given Protonix again, was on it after surgery, but now a stronger dose...

I went to my surgeon, actually his colleague in the same office and she advised to up the dosage of the Protonix and get an end and some studies done.

I did that -- they did some Xrays, a CT scan, endo and colonoscopy and I was told stay on the meds at this rate for at least 3 months. She said any changes or its worse, come in and see her before the 3m time and since she was ready to give birth any mind, said to see her colleague. I did just that - she's out on maternity leave and I saw another dr. in her office and he suggested upping the meds again, to 2x per day and another over the counter at night time so avoid the GERD issues. I can't keep anything down, you'd think I would be thin LOLLL it's the opposite, I'm maintaining, but I have GERD 24/7. Its horrible, even water does it.

So long story short - he said he would recommend the revision, which she did too - as well as fix an umbilical hernia I have that bothers me.

The surgical coordinator called, temporary scheduled for March 18 for a revision, said he will get pre auth from GHI, my insurance and if it's weight gain, don't get my hopes up of it being approved.. he's always been a non friendly guy, even years ago, it's like I'm bothering him. He must deal with horrendous people all day to act the way he does, but besides that.... He said don't get my hopes up and he'll pencil me in for March 18. He said I didn't come back to the office for years, erhmm, why should I - I was feeling fine... Gastro doc told me my GERD could be due to the sleeve and to go back to my surgeon, which I did - has nothing to do with weight gain - I'm not dealing with GERD for the rest of my life.... It's really really bad.. Anyway, GHI said they cover the procedure, just needs pre auth and it could take 7-10 days to get back... so I'll keep my fingers crossed and not listen to the surgical coordinator guy ... maybe he needs a drink LOL

Anyone have any luck with GHI/Emblem Health for the revision - my husband carries City Of NY coverage of GHI.

Good luck all

So are you getting bypass?

I guess so. If insurance covers it!
I need to feel better. I can’t take it.
but to be told don’t get my hopes up is ridiculous

Your surgeon needs to write a letter to say it's urgent you can't live with the gerd reflux!

I had RNY bypass 3 months ago doing great!!

16 minutes ago, Superman84 said:

Your surgeon needs to write a letter to say it's urgent you can't live with the gerd reflux!

Yes. They claim it is. And because of the GERD. Unsure what they’ll say cause this surgery coordinator is a jerk and he does the paperwork.

23 minutes ago, Superman84 said:

I had RNY bypass 3 months ago doing great!!

Awesome. I’m so jealous lol

I hope they approve it. Penciled in for March 18. If all goes well.

68lbs since surgery day

1 minute ago, Superman84 said:

68lbs since surgery day

Nice!! Good for you ...

you had sleeve before hand?

No way i never wanted it ..went straight for bypass

Just now, Superman84 said:

No way i never wanted it ..went straight for bypass

Oh. I went originally for lap band. Went for sleeve. Should have known and won’t bypass then.

We've successfully helped several GHI members get revisions so please be optimistic - BTW, whether or not you regain weight is IRRELEVANT since changing eating patterns due to severe GERD is not only common, but often a necessary way people can tolerate ANYTHING! Let us know if you're submission is denied before anyone at the doc's office does something that might hurt your chances of being approved and GOOD LUCK! GERD really sucks so hopefully you get approved without a problem.

5 hours ago, Walter Lindstrom said:

We've successfully helped several GHI members get revisions so please be optimistic - BTW, whether or not you regain weight is IRRELEVANT since changing eating patterns due to severe GERD is not only common, but often a necessary way people can tolerate ANYTHING! Let us know if you're submission is denied before anyone at the doc's office does something that might hurt your chances of being approved and GOOD LUCK! GERD really sucks so hopefully you get approved without a problem.

Oh. I’m very optimistic. They said it’s covered w the procedure code given to me by the surgeons office. It’s ok by the insurance website stating covered due to medical necessity. I have all documentation. Endo. Put on drugs. Swallowing tests. I did everything the surgeon told me to do months ago and have been patient even though I feel like crap everyday and vomit more times they I can count. She even asked me why I gained a little. I gained due to trying to keep acid at bay and see if food can do that. Even water gives me heartburn. It’s ridiculous. I just think this coordinator is miserable with himself. And deals with people all day and he can’t handle it maybe. I don’t care. Cause I will appeal it if it comes back. I’m not leaning towards that though. What do you mean till the hurt my approval. Why would they hurt my chances? He wants me to believe it’s not covered and because I wasn’t seen in the office over the years. Shouldn’t be a deciding factor. I didn’t need a surgeon

There is "tilt table" xray they can do to prove GERD. You swallow barium and they tilt table with head down. Can actually see the barium reflux up. You might ask your center if that test proving reflux would help qualify you.

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Denied - I'm so angry!!! day before presurg testing tomorrow.... and the surgical coordinator is going out of town for a few days, I'm on hold now with the insurance... ridiculous!

How do they want 6m of clinical, which is what I did last time, when it's GERD and it was a gastro issue...

They used code 43644