You All Are Not Going To Believe This One!

[HuntingGunDogs 5]

I have asked for help with all the GSD info for OCC in Mexico set for DEC 27, 2011 SURGERY.

I was DENIED in the USA by BLUE CROSS as I am only, get this only, UGH, BMI of 38%

I appealed the HELL out of the denial and my DR's also helped with GREAT letters.

APPEAL APPROVAL for USA Roux en Y bypass surgery APPROVED as of TODAY

I am now scared. REALLY scared

Please all, tell me what U think of this surgery for weight loss.

HELP me, HELP me, HELP me.

All info will be GREATLY appreciated

Susan cook, HGD's

CALIFORNIA

[TijuanaPlication 87]

Hi, please see what I wrote on RNY here http://www.verticalsleevetalk.com/topic/18102-sleeve-vs-bypass/

I wrote in the thread that I didn't know how much Protein is malabsorbed with the Dudoenal Switch (DS), I can tell you it's ~50%.

I really don't think that RNY is a good option (think of poor Carnie Wilson... from Playboy to back over 300lbs). I kinda say the same thing here http://www.verticalsleevetalk.com/topic/22823-help-need-input-and-advice/

If you qualify for RNY then you qualify for the DS. Obesityhelp have a DS forum and Diana Cox has helped many with insurance appeals.

The DS requires compliance with protein and taking Vitamins, so you really need to research and do a lot of reading. www.dsfacts.com also has a lot of info.

HTH

[HuntingGunDogs 5]

I feel like I am starting over again on RESEARCH. I will find out more on MONDAY when Dr GAnsers office calls me.

UGH

Thank U so much for all UR great info

I will start on the research this weekend....

It has been such a SHOCK that the BLUE CROSS Approved my appeal.

Wow

S

[TijuanaPlication 87]

Note that not all docs do the DS as it's a difficult surgery to perform, in which case he's not likely to advocate it as an option if it's not something he offers. dsfacts.com lists vetted DS surgeons, getting a good surgeon is extremely important and can't be emphasized enough, as there have been tragic consequences of not getting a vetted surgeon.

I feel like I am starting over again on RESEARCH. I will find out more on MONDAY when Dr GAnsers office calls me.

UGH

Thank U so much for all UR great info

I will start on the research this weekend....

It has been such a SHOCK that the BLUE CROSS Approved my appeal.

Wow

S

[HuntingGunDogs 5]

AT this point, I am so confused I need to back off and start over next week on NOV 28, researching again

The BIGGEST issue for me is the aftercare

If there is issue, I would have to go back to Mexico for follow up

This clinic will cover all if there is needed surgery intervention, etc

I originally went forward with the Roux en y 10 ys ago. Denial and 2 appeals DENIED.....

I went forward this time to Dr GAnser in RENO NV and at 38 BMI and shot knees, MANY Co morbididities, the INSURANCE DENIED me

I was PISSED

I sat down and put the pen to the Paper

Set up OCC as I was sure this was gonna be a denial on my initial appeal.

I have to tell U, that was a DARK DARK moment to open that original denial.

I bought plane TIX and put the deposit down.

APPEAL APPROVED.

UGH

I am just so overwhelmed, I cannot go forward on the Duodnal Switch issue now.

It is cancel MEXICO at OCC for the SLEEVE and go for the USA Roux en Y bypass.

I am confused, scared and overall in disbeleif I got approved for USA

I have a few friends that had complications with the Rouex en Y ys ago and were in medical need , one over $100 K

If I have to endure drama over the SLeeve in MEX, I gotta pay for it

I have to protect my assets , what little I have left , as we are at retirement age and I have a small business

I will know more on MON Nov 28 when I contact the USA Bariatric clinic in RENO

I emailed the letter from Blue Cross and will get all my answers on that process MON or TUE

OVERWHELMED

S

[mednar 26]

I had a long draft that I somehow lost track of. Regardless of the procedure that was approved, you need to weigh the benefits of that procedure against what your ideal is. If they don't match to your satisfaction, you have to seriously consider if someone else paying is enough to overcome the short and long term disadvantages.

TijPlication has talked about her struggles and regrets, including what she would consider revising to. Please read those.

I had all sorts of issues standing in my way regarding different procedures starting 3+ years ago. This has worked for me, but for many others they have had mixed results. For me, when I first investigated this path, nothing matched. I knew up front always that I would be self-pay. I made sure to review my options. When the sleeve plication became available, it met all my criteria. Even if my insurance had offered to cover another procedure, I wouldn't have been able to commit. At this point, making the self-pay sacrifice has been worth it.

Gah. I was much more clear before. Be honest with yourself about what you want, research whether or not that's possible with what your ins. co. is offering. Above all, investigate your physician, their patients, and how happy they have been. Ask to speak to some of their patients, either during seminars or individually.

Don't make a fast decision because you feel pressured. There's enough of a market for this surgery now that you can research the best procedures for your situation and your insurance/financial situation. I'd say above all, don't go for what the best option your ins. co. is willing to pay for at that moment.

Reflect, Research. Reflect, then Reflect some more.

Success and all my best,

Mednar

[HuntingGunDogs 5]

I totally agree

I did not cancel OCC in MEX and I fired off alot of emails to the Clinic in RENO with WESTERN Bariatrics about my shared cost for the HOSPITAL, DR and ANESTATIST.

I will also get into the Roux en Y chat line

I will know more on MON

The same mail batch on FRI, I had a letter from the State Dept saying my Birth certificate was not embossed.

I just got online and ordered a RUSH for an EMBOSSED copy for the State Dept.

I am not even sure if I can now get the passport here by DEC 26

UGH

I sent all this to Carolyn at OCC and am waiting till it all comes together Monday and thru next week

What a life

Thank U for the info

S

[HuntingGunDogs 5]

Mednar, Did U get the BAND??

How are U anyway?

I forgot to check.

Weigh loss happening??

S

[Shellyac 22]

If having the band isn't a personal problem for you, you should check to see if your insurance will also approve the band. If they do, you may be able to get the band with plication. I believe that there are a few doctors on the West coast that preform the band with plication, I have also seen it referred as iBand. I am getting the band with plication done in January and my insurance (BCBS) is covering the surgery 100% even though I am having it done in Florida (I live in Maryland). I think that this procedure is a great option because you have both of the advantages of the sleeve and the band. The band will help give you additional restriction if the plication isn't enough and it should be harder the "cheat" the band because even if you eat foods that can slip the band, you have a plicated stomach instead of the normal sized stomach in the traditional band. Also this procedure is reversible which was the biggest issue for me.

Michelle

[HuntingGunDogs 5]

Blue Cross agreeing to the Laprascopic RNY bypass procedure with the one nite hospital stay SHOCKED me and as of now, I am not sure what the hell happened. I must have writtne a hell of an appeal.....

I have done alot of reserach and tonight I went over the Duodenal switch surgery. What an invasive procedure that seems to be....

Not alot of research results out there and from what the info I found said, only 50 doctors in the USA are doing it....

In as much as the Band over the Sleeve, I have seen it but not as a surgery that was addressed much in my travels.

That band seems to be something I kind of wanted to stay away from.

Just that fill situation and they dealing with the foreign object in my body made me feel kind of queezy.

Not sure that one would be for me.

S

[TijuanaPlication 87]

I'm glad you researched. The DS is a big deal and not a surgery to be take lightly. I personally think that the VSG as an initial step is a good option, then you have the option to revise to the DS if you need it (although you're likely to be a slower loser doing it this way).

I met with a great surgeon in my Quest for a revision and he thought that adding a band is a bad idea (maybe it's not so bad to get it done up front, IDK that ship has sailed for me). He said that my research was good and that the only good revision option is getting DS intestines.

Blue Cross agreeing to the Laprascopic RNY bypass procedure with the one nite hospital stay SHOCKED me and as of now, I am not sure what the hell happened. I must have writtne a hell of an appeal.....

I have done alot of reserach and tonight I went over the Duodenal switch surgery. What an invasive procedure that seems to be....

Not alot of research results out there and from what the info I found said, only 50 doctors in the USA are doing it....

In as much as the Band over the Sleeve, I have seen it but not as a surgery that was addressed much in my travels.

That band seems to be something I kind of wanted to stay away from.

Just that fill situation and they dealing with the foreign object in my body made me feel kind of queezy.

Not sure that one would be for me.

S

[Shellyac 22]

In as much as the Band over the Sleeve, I have seen it but not as a surgery that was addressed much in my travels.

That band seems to be something I kind of wanted to stay away from.

Just that fill situation and they dealing with the foreign object in my body made me feel kind of queezy.

Not sure that one would be for me.

S

My main reservation about any surgery is that I didn't want to do anything that was permanent, my original surgeon and her coordinator tried to talk me into having the bypass because they felt that the band would not be as successful a procedure for me and when I expressed my concern about the permanence of bypass she even told me that it was reversible (technically true but it is a difficult procedure and as my new surgeon says "if a surgeon says that it is reversible, ask them how many they have done"). After they tried to talk me out of the band I was filled with doubt and started looking for other procedures. Since I am committed to having surgery, I decided that if I was going to do something permanent I was going to do the sleeve because I had a cousin that had it done a few months ago and based on how she was adjusting I thought it was something that I could live with and I didn't want to deal with the issues related to bypass like dumping syndrome. But fortunately for me, while I was researching the sleeve I found out about plication but because it is a new procedure it was something that my original surgeon didn't preform it and there was no way that I would even qualify for the sleeve because my insurance required a BMI of 50 or higher. I was resigned to waiting until plication became an approved stand alone procedure (something I believe will eventually happen) when I found that there were some doctors that were preforming the plication in addition to band but there weren't any that I found nearby. I ended up choosing a doctor in Hollywood, FL mainly because I can recover at my parent's home for the first few weeks after surgery.

I understand your concerns about the band. I am concerned about some of the difficulties with the procedure such as getting stuck, but the great thing about the combo procedure is that you need fewer fills than just having the band alone and there are even some people who don't even get filled at all. For me I plan on thinking of the band as the back up. Also I know that some people have issues with having something "foreign" inserted in their body and to that I just ask, if you were told that you needed to have a pacemaker inserted to help keep your heart beating or if you needed an artificial knee or hip to help you walk would you still be freaked out about a foreign object inside of you. I look at the band a something that I am having put into my body to help improve my health and to me it is no different than that pacemaker or artificial knee.

[HuntingGunDogs 5]

The band is more than all that. The FILLS I do not want to mess with

I think the more I research, the RNY is the way I will go

I would not have the RNY or the DS out of country

I want coverage for future stuff with my Surgeon in the USA paid by INSURANCE

I am leaning toward the RNY

I will know more MON

S

[Jenn 27]

I am a revision banded plication patient, however I plan on never ever get my band filled. I was originally banded in 2001 and did fairly well with it until my band slipped. I was considering the sleeve as well but could not get over the idea of 80 percent of my stomach being thrown away. My procedure was also covered by insurance.

[HuntingGunDogs 5]

I am so shocked I won this appeal

I have been walking all around in a daze since Friday Eve when I opened the mail

I got onto alot of websites, did more research and looked into the Duodnal switch like T. Plication suggested

I am seeing alot of simalarities with the RNY and DS. Not sure I want to go with a new VERY Invasive procedure when RNY is tried and true now, being done with lots of confidence and experience

The plication was the one I originally went for and set at OCC in MEX

I changed to the SLEEVE

I have seen alot of GREAT success with the Band and ALL of them really

Not sure what the answer is and why it works for some and not others

The thing I like with the Clinic in RENO NV is they are 62 miles from me

I can rely on the classes, support meetings and if anything comes up, they are there

The band was what I originally went for there and the DR talked me into thinking HARD on the RNY vs the BAND

I met a guy that had the band in the Waiting Room. He lost 100 pounds with it and is still loosing

Not sure why some gain their weight back, do not need fills, eat stuff easily, conform to the new lifestyle and never look back and others FAIL having lots of issues

I wonder if it is the fact they do not use the surgery as a tool VS a catch all to total weight loss thinking they do not have to work at new habits with the surgical assistance.

I guess I will find out.

I see that Western Bariatrics also do the SLEEVE on a limited basis. I will ask on that MONDAY when I call with all this new found news .

I love this chat site by the way.

I went into the RNY sites and was LOST

I feel at home here

Thank U all.

S