lolarose13

Yeah. I got my revision to bypass last week. So far, this has been easier than the sleeve, and I’m just exhausted, but nothing hurts. I had horrible GERD, so they corrected a large hernia and cut my prior sleeve even more, to make it look good (it was enlarged). After all, the surgeon said everything looked great, and I felt ok. I’m hungry, but I think this is more mental than anything. I need to lose around 50 pounds to meet my goal. I was around 20 pounds short with the sleeve, but I could not do it.

I had my sleeve to bypass revision last thrusday. how is everyone doing?

So I appealed to Aetna, and they still said no. Thankfully my husband changed jobs, so I moved to his insurance, and now I have Anthem! I looked at their guidelines, which seem much more straightforward than Aetna's. My doctor will submit everything again today. Unfortunately, my doctor only will perform the surgery if they approve me for the bypass and not the hernia repair, so I’m hoping this works! Wish me luck! 🍀 I’m so tired of going through the hoops, and I’m feeling horrible, so I need this so bad 😭

I just switched insurance to Anthem. I got denied by Aetna because they wanted me to do this stupid ph 24hr test. I appealed, but they didn’t care. So I was able to switch since my husband was moving jobs. how was your experience with them? mine is a revision to bypass.

Hi, what test did you have to prove it? I just got a denial for revision because they want me to do a pH 24hr monitoring test to probe my GERD. I appealed because my GERD has been documented, and I have an EGD done showing that I have a large symptomatic Hiatal hernia, but I guess they want this test to prove it...I’m very frustrated.

I feel you! 😫 I submitted an appeal today, wish me luck! I will keep everyone posted 🤞🏻

Thank you! this is incredibly useful information. My doctor suggested filing an appeal just for the unnecesary burden of going through this test since the symptoms have been documented for years. Did you have to stop your meds before the procedure? I cannot even imagine trying to do this if I can barely make it without them; I want to cry!

Hi guys, So Aetna denied surgery conversion to bypass because they need "extra" proof of my GERD. They recently changed their rules and are asking for a PH Probe 24hr monitoring with abnormal results. I talked to my GI, and he told me that in order to do this test, I need to temporarily stop using medications that suppress stomach acid for about a week before the test; WHAT!? I can barely leave without them (I take a double dose, morning and night, and I am still waking up choaking most of the time, I have horrible reflux, etc.) and they will make me go through this just to prove that I have horrible GERD? I talked to my doctor's team, and they believe I should file an appeal just to explain this unnecessary burden and suffering, as this is the first time an insurance company required this test. Does anyone have an appeal letter as an example that I can use to start this process? I'm just so upset about this is ridiculous. Thanks!

Can you tell me more about the PH monitoring? I don’t know what to expect if we go ahead with this. I thought finding a hernia would be enough, but my doctor submitted me a GERD revision.

I will have to talk to my surgeon about this. My insurance just denied my revision because they wanted to prove my GERD with a 24hr PH monitoring test! I already had an endoscopy and the doctor found a large hernia, but now they want me to prove my GERD with a super expensive/extensive test? I’m upset that my doctor wants to go ahead with this.

I got denied yesterday by Aetna. They changed their rules, and now they want 24 abnormal PH reflux monitoring to prove my “GERD.” Gosh, I hope my doctor tells them about the hernia, and we can get approved because of that or get that surgery + the bypass. How big was your hernia? Mine is 4cm, which is big (I imagine) since I’m a very small person. Wish me luck!

Hi! do you mind telling me what your insurance is? I have Aetna, and I have a feeling this is going to happen with me since I have GERD and EGD only showed a Hiatal hernia.

I’m so glad this is working for you. I also have Aetna. I have GERD, but the EGD only showed a hietal hernia. I looked at the guidelines and they changed the requirements if get a revision to bypass only for GERD. I’m hoping the hernia repair will be enough to get approval. anyone knows more about this?

hey! how was your surgery, how are you feeling? I’m on the same boat trying to get the surgery. Same thing, GERD after sleeve, EGD showed an hernia and I want to get revision to bypass. My BMI is 31 and my fear is that my insurance won’t cover it 😢

I’m on the same boat. I already started the process to get a revision to bypass with a BMI of 31. I had very bad GERD but the EGD only showed up a hietal hernia, and I guess Aetna guidelines says esophagitis. I’m terrified they would not approve me because of this 😭