So frustrated, 1st appeal denied

[Cia2020 77]

My surgeon's office appealed with the EXACT same language as the first request to go from VSG to an RNY which was denied. Hello month wasted, of course they would deny it again. What's that line about repeating the same behavior expecting a new result? Sheer laziness! 😡 I'm currently waiting on a call back from the appeals department at my insurance for clarification on one of the points of the revision criteria:

Weight loss to 90% or less of ideal body weight

If my understanding is correct, since I only lost 27% of my excess body weight and I'm a good 55 pounds from my ideal body weight (not even my goal, but I'm 35 pounds from that too and only lost 24 pounds total) I could be considered for revision. What I find is ridiculous is I have a few cm sliding hiatal hernia visible on my upper GI literally every time I breathe, hiccups countless times a day associated with that, GERD no responding to PPI use resulting in mild (so far) esophagitis, and documented dysphagia just with liquids on a swallow study done plus I've had vomiting with foods like meats that got "stuck" because my esophageal muscles aren't working properly anymore. All of which would be resolved with revision to bypass.

Add in I have family history with cancer on both sides, including with my grandad and aunt on my dad's side who had stomach cancer (removed whole stomach) and esophageal cancer (multiple bouts) respectively, and this scares the crap out of me. I don't want to be on a PPI for years, which is not safe, or wait until I have 4 months of documented severe esophagitis that could turn cancerous. Not to mention what this could do to my asthma and high blood pressure during this whole Covid era, neither of which were resolved by the initial surgery either. Why does insurance have to be such a 🤬 ?!!

[lizonaplane 1,605]

I'm sorry you're facing this. I hope you get it sorted out! Good luck!