lulugirl

Sleeved July 2012 in Mexico with Dr Garcia. My BMI was about 37 y insurance wouldn't cover surgery due to not having any co-morbidities. I also had a lap band done July 2007 in Mexico with Dr Aceves & had that removed July 2010 which insurance did pay for. I have had constant issues with reflux with my sleeve. I have lost weight & have been keeping it off but very difficult for food to stay down. I am also lactose intolerant since my sleeve surgery! I had GI tests done to confirm my GERD issue, the surgeon feels the only way to fix it is to have a "gastric jejunostomy". This is basically a revision to a gastric bypass. I was scheduled for 718/14. Today I get a phone call from the coordinator who said it was denied by my insurance. I am copying the reason from his email below: MMSI denied based on benefit interpretation. Procedure is non-covered and is an exclusion on Bariatric Surgery policy under heading “Not Covered/Exclusions”: Complications of (any) bariatric procedure when surgery was performed without meeting criteria for the procedure. I.E. gastric band and sleeve gastrectomy done at an outside institution (didn’t meet criteria) I am so upset, basically he told me I could appeal. Well I called the insurance company, spoke with a rep who advised I cant appeal due to it being a "pre-determination issue" If I go ahead & have the surgery & am denied, I could then appeal" Well I don't want a 50K bill from the hospital, so I cancelled the surgery. It is weird but when I came back from Mexico form being sleeved, I had C Diff & was hospitalized twice, insurance paid for all of it! Again they even paid for my lap band removal which was removed due to difficulty eating fruits, veggies, meat in 2010... I continually throw up throughout the day after I eat, alot of liquid & small pieces of food.. Also my husband is covered under my insurance & he is on dialysis 3 days a week & on a kidney transplant list,, Maybe my insurance feels we are costing them too much.. I just don't know what to do anymore..

It has been a long time since I last posted. It is now 2017 & Im still suffering from reflux. Just had an EGD which shows esophagitis & reflux issues. I recently retired & now am only covered by Champ va insurance. My doctor is recommending surgery again & her office just called & said my insurance approved it. I am scheduled 7/11. I am still worried that once I have this done Champ va will try not to pay it since I didn't go through the weight loss protocol back in 2012 when I went to Mexico. I need the revision for reflux, not weight loss. I am so tired of everything I eat coming back up, also I'm not able to digest salad, veggies or fruit. Also lactose intolerant since my sleeve. I really hope this works.. I have kept my weight off, I'm 125lbs..

It was denied due to I didn't go thru the required weight loss procedures that was needed for my sleeve! My doc tried to get it covered due to my reflex but still was denied. I can't complain too much because they did cover the removal of my lap band back in 2010 & I had that done in Mexico. My doc did say if I get Barrett's they would have to cover the procedure. It has been a year since my last EGD, now I'm wondering if I should have another one done..

Ok, it has been along time since I last posted. My revision was denied by my insurance so I never had the surgery! Still living with reflux but able to eat a little more. Still taking Prilosec in am & pm, just trying to enjoy my life! Also the reason My insurance denied the surgery was because I didn't go thru their "rules" when I had the sleeve surgery in Mexico.. I do worry about getting Barrett's but had an EGD last year & all was good. Hope you all are doing good!

How soon did you have these issues after your surgery? I started having these issues about 2 weeks after my sleeve surgery which was 2 years ago. I did get a phone call from the surgery cordinater last week. He said my case was discussed at a meeting with my doctor & she was going to contact the insurance company to discuss my case! So I am hoping that I will be able to have it done. How are you feeling after your revision? Please keep me updated on your progress!

I love reading all your comments, they give me some hope I can get the revision. My insurance is telling me that there is no appeal process for this because I am being denied due to a pre deterimnation clause that states "I wasn't eligible for weight loss surgery under their guidelines, so they won't cover the revision to fix the reflux". i guess they feel the reflux is due to a complication. The coordinator did email me the link that shows this in the insurance guidelines. I copied the wording in my original post, I am in Arizona. I was self pay in Mexico in July 2012 & have had reflux issues since.

Thanks everyone for your replys.. I am so scared now that if I get a leak or something goes wrong with my sleeve, my insurance will never cover it.. I am covered by my insurance through my employer, been working there for 9 years. It is a large organization in Arizona. Stil kind of shocked it was denied.

Ok, I am now scheduled 7/18 for a revision to gastric bypass! Im scared to have another surgey but I don't want to live with this reflex anymore. Also Im hoping I won't have an issue with my insurance company..Should know soon.

You may see if they can give you Nexium. It's expensive so not all insurance covers it but if your doctor deems it medically needed that would help. I like Nexium for acid way better than Protonix and Prilosec and Zantac and if those aren't working it is logical to try something else. Good luck with the appointment! I have an appointment on Monday to schedule my revision. I'll keep you guys updated and most likely start a new thread with my whole experience. I guess someone has to be the guinea pig and I need a permanent fix so I'm going to volunteer! Hopefully I have a good experience and it helps you guys decide what's best for your future!

I can't believe I just saw this topic! I will be 2 years out in July from my sleeve surgery. Not only do I have horrible reflux issues, my blood sugar started dropping about 10 months ago! My PCP said just try to eat more Protein & eat every few hours. My husband is a diabetic & he will check my sugar level when I feel an episode coming on, has gone down to the mid 50-60 range! I always keep glucose tablets with me & will drink apple juice to bring it back up. I am also scheduled for a revision to gastric bypass on 7/18 due to my reflex issues. Sometimes I regret having started on this weight loss journey. I am down to 123, it is the thinnest I can ever remember being..Just wish I wasn't having issues.

I feel your pain! I have had constant heartburn& reflux since my sleeve was done July 2012.. I never had issues until I got my sleeve. I believe this may be one of the issues with getting a sleeve. Are you taking any meds for this? I take Prilosec & also Zantac on a daily basis. I just had some GI tests done & see a surgeon 5/15 for results. I may be revising my sleeve to a bypass. Speak to your Doc about what you can do to resolve heartburn issues. It may also go away after you are healed.

This was an interesting post.. I had my sleeve surgery July 2012 in Mexico & got C Diff. My doctor said he couldn't say if I got in Mexico so I am still happy with my surgery! It took 4 months & 2 hospitalizations to get rid of this! I ended up in a research study where they gave me an infusion, not sure if I got the actual medicine but was told if I didn't get better, a fecal transplant would be next! My insurance took care of all costs associated with this! Please post an update on this! hope you feel better soon!

Hello, everyone! I have posted previously in this thread about my horrible reflux since my sleeve surgery July 2012. I finally had the barium X-ray last week & am now sitting here with a Bravo monitor that was placed yesterday. I kept putting these tests off because they are so awful to do & I wasn't sure I wanted to go thru bypass surgey. Well, the Prilosec & Zantac that I have been taking daily for almost 2 years seems to not be working. I see the surgeon 5/15, so will know then if I can get a revision to bypass.. I NEVER had reflux when I was overweight & I would eat lots of junk!! Im also lactose intolerant now so it is difficult for me to eat. The good thing is I now weigh 122 lbs!! However, I would give anything to be able to eat fruit, veggies, salad once in awhile ! Maybe even enjoy an ice cream cone! Take care!!

Oh I also need to change my ticker, I now weigh 123 lbs & don't want to lose anymore weight! Never thought I would say that!!!

I had my sleeve done July 2012. I never had reflux issues until I got the sleeve. I am finally going in for tests this month & may be getting a gastric bypass done. I was suppose to have these tests last year but I keep putting them off cuz Im not sure if I want to go thru with more surgery. I also became lactose intolerant after my sleeve was done! I have lost a lot of weight & am keeping it off.. I just get tired of vomiting every time I eat.. It happens every day. I am also experiencing low blood sugar, has gone down to low as 48! my PCP doc says I need to eat every 2 -3 hours, small meals & more Protein. It is still hard for me to get food down. I am not diabetic.. I hope things go well with whatever decision you make!

Hello, I'm so sorry to hear that you are not doing well! I posted in this thread a month or so ago. I'm still having reflux issues but have put off the bypass surgery.. I am now done to 123 & don't want to loose anymore weight! Never thought I would ever say that in my life.. I still take my Prilosec & have good & bad days! I hope things get better for you!

I also have severe reflux & need to take Prilosec & Zantec dailey. Had sleeve done July 2012 in Mexico & have had difficulty eating & drinking since then! Also got a C Diff infection & was hospitalized twice last year for it. I ended up seeing an infectious disease doc & finally tested negative for C Diff in Dec 2012..I have had an EGD with dilation & the surgeon I saw last year in the United States wanted me to do an EGD with a bravo monitor.. She discussed that I may need to convert to a gastric bypass.. Anyway I kept putting the second EGD off because I was dealing with the C diff issue & had missed a lot of work! I cant stand this reflux, vomiting everyday.. & Im also lactose intolerant now! I have an appt with the surgeon tomorrow to discuss any options I may have.. So far my insurance has covered everything that was done last year, no issues.. I was self pay for sleeve in Mexico. Glad to read about this issue in this forum! I am happy with my weight loss, just tired of vomiting daily..

I will be 1 year out in July 2013.. Had surgery in Mexico with Dr Garcia.. Yes I did have issues but have lost over 70lbs.. This is the smallest I have ever been.. It feels so good to buy clothes ! I still have issues with reflux, I take 1 prolosec in am & 1 in pm.. My insurance has covered all my after care, including 2 hospital stays for a C Diff infection. Also I still struggle with food. Sometimes difficult to eat with the reflux. One of my docs wanted to convert my sleeve to a bypass but I dont want to do anymore surgery.. I was suposed to have another EGD last Fall with a monitor placed for 2 days but I didnt want to do anything at that time.. My C Diff finally went away in December. Ok, so Im actually going to try & attach pics.. One is of me & my son from October 2011, I probably weighed 185.. The other 2 were taken a few days ago at 129 lbs! I never liked to take pics before so it feels weird to take them now.. Good luck to all in their weight loss journey!!

hi , I went through a "lighter me". I don't think they use Dr Garcia anymore.. Good Luck !

Sleeved 7/9, almost 8 weeks out. I still can't get fluids, Protein in. I am always full after just a few ounces,. Had ann EGD & an Esophageal motility test done 8/28. It showed food is not emptying from my stomach. The GI doc now wants me on a "gastroparesis" diet. No fresh fruit or vegs, lots of blended foods. I also have a follow up with him 9/18. I probably only get about 16-24 ounces of fluids in daley & just some Soup once or twice a day. It is a big struggle. My weight today was 168 so I'm losing. Just hard because I get so weak & tired. I had no health issues prior to my surgery..Not sure why this happening & I'm getting scared.

hello! Well I still have issues.. still have my c diff infection & am antibiotics! I am seeing an infectious disease doc who has advised I may need a fecal transplant if this is not cleared up by December. It sounds gross but they do it during a colonoscopy.. I still have food issues but seem to be able to get more food down, still have problems with liquids. I'm also scheduled for an EGD with a holter monitor 12/5. Still have heartburn issues. My weight is 153 which is the lowest I have ever been & have had fun buying new clothes! I just wish I didn't have all the health issues. Hope everyone is doing well!

I was sleeved 7/9 in Mexico & am also having issues. I have had an EGD w/dilation, swallow study, esophageal manometry, & am scheduled for an EGD with a monitor in two weeks. I continually vomit up bits of food, have horrible reflux,, even Water is difficult to drink. I have even been told by one doc I am malnourished & that is one of the reasons I am having trouble fighting off a C Diff infection! Anyway, The surgeon thinks converting me to a bypass will help. I pray you are able to get the help you need to get better!

I have now been hosptalized twice & have had numerous tests for issues since I got my sleeve. I have horrible heartburn, reflux issues & have seen a surgeon who wants to convert me to a bypass. I'm scheduled for my 2nd EGD procedure 10/31. I somehow got a C Diff infection & just finished with my 3rd round of antibiotics. have been hospitalized twice for it. My insurance has covered everything so far. Even though I still have difficulty eating & I can barely get Water down, I don't know if I want another surgery again. Also I only have about 3 weeks of FMLA left for the year. I had to use for myself as well as my husband who is on a kidney transplant list & had to go on dialysis recently. It as not been a good year for us!