rhplus

I was recently converted from a sleeve (6-10-2013) to a RNY (11-7-2023) because of GERD. Getting insurance to cover it took 8 months. 4 appeals. And Multiple calls and emails all the way up to the VP of the company. I work in medical education so I fought and fought and fought and finally proved they had an immense amount of bias towards obese individuals. They kept denying me because I "gained weight" and "just want to lose more weight" that I "don't have GERD". In that 8 months of proving I have GERD I had to have an EGD, Barium Swallow, Stress Test, Colonoscopy, and a PH Monitoring study (that was the really crazy one).... and they were positive for GERD. They kept insisting that no they weren't positive and if I just lost weight I wouldn't have heartburn. When I had my first sleeve I was 380 pounds I got down to 170 pounds in 2017. In 2022 when I started the program to get the revision I was 220. So yes I had gained some weight but NO I hadn't regained all my weight. My entire experience has been very eye-opening how quickly someone in insurance will deny obesity as a medical condition and say it is a lifestyle choice. Especially when the entire point of the conversion was to fix GERD and not lose weight! If you seek to have the revision my advice is keep all the framing on GERD. Don't even reference weight or weight loss. It has to be for GERD. Study that insurance companies weight loss surgery policy and reference it often. It is best practice to convert a sleeve to RNY to fix GERD. And craziness I had the conversion and haven't had GERD once since! Don't let them tell you no. If the tests prove you have GERD get the conversion.