revision in TX

SoccerMomma73: I actually got a call from UHC on Friday last week, saying that they were referring my "case" to another dept to follow-up on my surgery. The rep told me that, regardless of anything else, the MD agreed to accept whatever was paid as "payment in full" (by out-of-network provider), so I am entitled to either what I paid OR what insurance paid them. She said the dept they are sendig it to will have more time to pursue it than the Customer Service Reps do, so they should have some kind of answer for me within 60 days MAXIMUM. So, I'm in a holding pattern for now. But at least it appears they are in agreement with my viewpoint and will try to get the office to refund some of my money!! YEAH! (The hospital and anesthesia never billed me a penny beyond what I paid up front...only the surgeon!)

I had a revision, but it was from a Lap-Band to bypass. I had such severe reflux with the band that I had to have it "deflated" completely to relieve it. I had "esophageal distention" which is basically the upper part stretching along the side (not at the stricture), so it filled with food up above the band....causing severe reflux. My "hiatal hernia" was oversewn during the revision and I have been SO much better since then! I don't have heartburn or reflux or any discomfort at all!!! So, even though my revision was not from a sleeve, yes,...it DID "cure" my reflux/GERD pretty much completely. Best wishes in your journey!!!

Basically what happened is.....I have UHC, but this particular plan does not cover bariatric care at all. So, I paid for the surgery myself. Well, in order to get insurance to pay on the surgery, they billed "unlisted liver procedure" instead of wedge liver biopsy...."unlisted procedure, stomach" rather than gastric bypass...."adhesion repair" rather than lap-band removal...and also charged for a (hiatal) hernia repair. Mind you, all of those things were to be INCLUDED in my revision surgery (that's why it's more expensive than a "virgin" bypass), but they had my insurance information from my (original) consultation and submitted it. Since the coding "appeared" medical, UHC covered a pretty significant portion of it. Thinking I should get a refund for anything that insurance DID pay, I phoned the office to find out when I'd get a refund check and, to my surprise, they said they would be keeping BOTH payments! Adhesions were expected, due to the band; I've had a hiatal hernia for OVER 10 years, but the op report reads as if it was "discovered" during surgery!!! Adding what they billed insurance PLUS what I paid up front, my surgery was nearly $58,000!!! That is ridiculous. The average for bypass is $22,000, which is what I "self" paid prior to surgery. Just a side note....I had NO complications, NO unexpected/unplanned procedure and the hospital and anesthesiologist both wrote off ALL charges except what I paid up front...only the surgeon billed/was paid by my insurance company. I tried to "appeal", but UHC wouldn't since it was not a denial. The insurance commission only regulates insurance, not MD's. The Medical Board only cares if you have "injuries" (for malpractice), they don't care about how the MD codes the surgery. Most patients don't mind because, had UHC NOT paid, they would not have billed me anything....they would have just " settled" for what I paid them up front. Because the patient usually doesn't get a bill, most don't mind and/or don't complain when the doctor submits "medical" codes and gets payment. It is a common practice by bariatric surgeons (even the "good" ones!), but it's wrong, wrong, wrong. I am continuing to pursue it because I work in the healthcare industry and I am just so infuriated by all the fraud, abuse and waste in "the system" that I am not going to let them get away with this, even though almost all of them do it!! Sorry to go on and on, but I am just SOOOOO frustrated and angry that I go on a rant when I discuss it. I asked all the right questions, reviewed the contract, etc., etc., and I STILL got "used". I am still trying to work with UHC to either ask the doctor for a refund or else tell him he needs to refund it to me...even if I don't get it, I don't want the doctor paid twice. If your insurance doesn't cover your surgery and you end up paying yourself....BE SURE that you have an "iron-clad" contract and understanding with your physician about what will be billed and HOW it will be billed. As a side note, even my PCP said it's "illegal as hell" (quote, sorry for the language) the way they billed it; it's not just me being upset because I didn't get a refund.

I chose bypass over the sleeve, because I was unsuccessful with the band; I had a loss of almost 40 pounds when I first got the band in 2006, but gained a large portion of it back. I could eat a lot and I also had severe reflux/GERD and the band actually made it worse. Prior to having bypass, I had to have ALL the saline taken out of the band for relief. My other reason for choosing the bypass over the sleeve: RNY bypass is the "gold standard" of bariatric surgery, so I felt it was the most "tried and true". If I understand it correctly, the sleeve is RESTRICTIVE only, whereas the bypass is RESTRICTIVE AND MALABSORPTIVE, which I felt like I needed, since I was unsuccessful with the band (over time). I am hypothyroid as well (have been for 20+ years), so I felt the malabsorptive aspect was needed to give me the best chance of losing. Admittedly, I have a HORRIBLE sweet-tooth. Bypass has made me limit that to some degree; I don't feel well if I "over-indulge", but I am able to have a couple bites of chocolate here and there without negative consequences. Lastly, I chose bypass because even though the sleeve is a little less expensive, I just didn't feel that I could go through a THIRD surgery if the sleeve didn't work....financially OR emotionally. That's where the "gold standard" thing came in...I figured if I had to choose only ONE MORE surgery, I should go with the tried and true/gold standard! I guess I've been pretty lengthy here...sorry. But, those were my reasons for choosing the bypass...and I don't regret it at all...I only wish I had STARTED with bypass instead of the band...I was misinformed about the "reality" of the band's success. Maybe they didn't know at the time (it was pretty new) or maybe they just suckered me in...I don't know. Hope this helps....best wishes in your journey. There is no "correct" procedure; it's just what you feel will work for you and that you are comfortable with.

Cherry, I think you are far enough out from surgery that you should be able to drink just about whatever you want; your pouch will let you know if it's too much! You said you aren't having any problems with what you are drinking currently, so I would think you should be fine. I am 14 months out---I can drink a pretty large amount, as long as it's not carbonated!! With Water, I do fine; I can't drink carbonated beverages or fruit juice, but we're not really supposed to have those anyway. Water will go through your pouch rather quickly...it's not like a lap-band, that has a "sphincter"-type narrowing. You just don't want to drink too much in gulps, because it can stretch your pouch (over time) and you don't want that. Hope this helps. If you aren't sure, just check with your surgeon's office - I'm sure the office staff gets those kinds of questions all the time! Great Progress!!! You are a success story!

Kylebean, I had a revision from band to bypass in Nov 2012; I had had SEVERE reflux and esophogeal distention in my band prior to bypass surgery. During my surgery, the doctor "oversewed" my hiatal hernia (which I had for YEARS) and I still had heartburn immediately post-op. But, by about 3-4 weeks post-op, all heartburn was gone. I can't say I NEVER have heartburn now on occassion, but it is rare and it is usually my own fault because I overate. I am still on Protonix, but I am trying to go off it and/or only take it when I have heartburn for several days in a row....which, so far, I haven't. I don't know much about the "after-effects" of the sleeve, because I don't know anyone who has had it, but MOST people I know with a band have pretty bad reflux/heartburn; however, most bypass patients I know do NOT have it. I guess this isn't much help, but I think it shows that everyone is different and that, although you have it now, you may "get over it" as you heal from surgery. Five weeks out is not that far; you still will have a lot of healing between now and, say, 6 months or a year. Don't lose hope, but if you don't start seeing SOME improvement, definitely follow-up with your PCP or surgeon. You're doing GREAT!!!

I also had UHC, with a "bariatric" exclusion. I took money out of my IRA to self-pay for surgery; glad I did. But...be VERY careful. My doctor billed "other" charges to insurance; they covered most of them( because they were coded as "medical" rather than "bariatric". That would be fine IF I got a refund, but he kept it ALL! Now, I'm having to fight with insurance and the doctor to keep him from being paid twice!! After charging me $22K for the surgery, th ey billed ANOTHER $30K to insurance...which makes my surgery (billed) amount around $55K!!! What a scam! And...they get away with it, because you can't do an insurance appeal, because it was not denied. They code it as if you had all these add-on procedures ("discovered" at time of surgery--NOT!) so insurance will pay, but they will keep it ALL!!! Makes sure it's VERY CLEAR what (if any) is self-pay and/or what is insurance coverage; otherwise, they will bill both and make extra money off you. It is "the norm" in bariatric surgery practices nation-wide.

I had the revision from band to bypass in one surgery; I would not want to have to have 2 separate surgeries! I had no complications and am now 1 year post-op (bypass), doing fine. My surgery was excluded by insurance (all bariatric procedures), but I would think the cost for separate surgeries would be ridiculous. Also, the safety of anesthesia twice. If your insurance pays that way, I guess that's your answer; but, given the choice, I'd opt for one surgery. Just my opinion....from my personal experience.