One Surgery or Two?

[mysecondchance 9]

So I had a consult with my surgeon on Monday who told me we should go ahead and convert to the RNY. He told me we could do the surgery all at once, remove the band and do the bypass.

Today I get a call from his billing office saying that they cannot submit for the band removal and conversion to be done at the same time and I would need to have two separate surgeries. This surprised me and when I questioned them they did not really seem to have a good reason as to why.

So I called up Anthem BCBS (California) and asked them if for a bariatric conversion they require two separate surgeries and they told me 'No'. She even checked with her supervisor and told me they said 'No'.

I call back my surgeon's office and tell them I spoke with insurance and they do not have any policy against doing the removal of the band and conversion to RNY at the same time. She claims it is what some Director at Anthem told their office and that they have been denying their requests for the surgeries at the same time for other patients.

I don't know about you guys but I call B.S. If it's not in my insurance policy and I meet all the requirements for the conversion then why would they deny it? So she tells me I can either submit for approval for the two surgeries now or go get the Psych, NUT and PCP referral done now and submit for the one surgery later. I put everything on hold and am going to have them submit a request for the single surgery. I do NOT want to have to go through two surgeries. I mean, I will if that's what I have to do but I really just feel like they are trying to milk my insurance. I even called another bariatric surgeon's office in the same town and they said that it was at the surgeon's discretion and they do it either way depending on the patient.

What do you guys think? Am I being jerked around? Did you have to go through two surgeries or one? Did you have any trouble getting approved for the band to RNY conversion??

I just had my band removed November 4th. I was supposed to get my bypass at the same time only to wake up and have them tell me I couln't have the bypass at that time. I cried and was mad. Then my surgeon explained it and I'm glad she put my safety first.She said if they did it and cut above where the band was it could be very dangerous for me and if the cut below where the band was then the pouch would be too big and I wouldn't benefit from it. She said I had too much scar tissue from the band removal and my stomach was not strong enough and it would cause leaks. The stomach has to be cut where the band was and they have to make a hole for the re-routed intestine. My stomach wall is too thin and weak because of the band removal and that could end in disaster even death. So that being said I'm glad she put my life before my wants or her money. She said mid January but I'm going to take my grandson to Disney Feb 8th for a week so we decided on the end of February to the biginning of March so I can enjoy Disney. I was approved for both so i gues when i have it in March i won't need another approval. Not all Dr's will do it all at once for the saftey of their patients. I've read also that if we wait to have it after band removal we will have better results. Good luck, I hope this helps.

[reshiapooh96 31]

Well Folks, I was just approved to have band to RNY in one surgery. I am of a lighter weight, so I don't mind waiting a while before converting if it's safer. According to my Dr. It really doesn't matter if I wait or not, but if I choose to wait, the cost will be more expensive and it also means to be put to sleep again. Now I'm worried about what to do.

[Gaga2013 8]

Well Folks, I was just approved to have band to RNY in one surgery. I am of a lighter weight, so I don't mind waiting a while before converting if it's safer. According to my Dr. It really doesn't matter if I wait or not, but if I choose to wait, the cost will be more expensive and it also means to be put to sleep again. Now I'm worried about what to do.

You'll be fine. Your insurance approved both so having 2 shouldn't matter. My approval went as follows : lap band removal approved.

Gastric bypass approved.

My Dr was going to do it all at once but couldn't. We are setting a new date for end of February to first week of March. I asked her if I would need another approal and she said no. Anyways, good luck to you.

[oldoneyoungagain 200]

I wanted band removed and RnY at the same time, but was told insurance wouldn't allow it. So I had it in two surgeries, which was fine. I really didn't want two surgeries, but I also understood there could be complications, such as a weaker section of the stomach where the band had slipped and the staples could tear that section and then they would have to go back in and try to repair to stop the bleeding, and also scar tissue. In the end, bypass was less pain then having the band, and I have a very high tolerance to pain. But remembering waking up in a lot of pain with the band. Bypass didn't have near the pain. Also to have the band out I was in an out and home within three hours and didn't fill the rx for pain medication. Come to find out after the bypass the doctor told me I hardly had any scar tissue which was amazing because I actually had my gallbladder out, so had a total of four surgeries in the same area.

[revision in TX 38]

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.

[curlyRNYgirl999 2]

I finally met with my new surgeon! This new office is lightyears ahead of my old surgeon. Well organized, technologically advanced and patient focused. It made my old doctor's office look like a back alley chop shop. He spent about 20 minutes with me, talking and answering my questions. It was great! He is also all for doing it in one surgery (pending any complications during of course) and says that he almost always does them in one! I have a few things to do before scheduling but I am well on my way. Hoping for a Feb./Mar. surgery date! Just want to say to anyone who feels like their doctors office might be trying to make an extra buck on their health...do your research and don't give up, even if it means going to a different surgeon. I couldn't be happier and wish I would've come to this office sooner!!

Also...my old doctor's office. They NEVER called me back, EVER. It was very clear that they didn't care about me at all and I would NOT recommend them. Anyone in the Fresno, CA area stay clear of Dr. Swartz and go to Boone and Higa at ALSAMG instead. Your health is too important to spend it with people who just want money!

Edited December 21, 2013 by curlyRNYgirl999

[moviechick00 23]

I had it done all at one time. I had major issues with my band it would slip and the port would flip on its own causing extreme pain. My original doctors office closed left me high and dry to find my new doctor. I saw the new dr for maybe a year with out any good results from the band. I was always in pain. I got something stuck Christmas Eve 2011 had to drive almost 3 hours to see my doc. He pulled all then Fluid from the band. He didn't fill me after that I saw him in Feb. At that time he said enough is enough time to take it out. It all got approved and I had my revision 5/12. Best thing I could have ever done. Good luck with your upcoming surgery.

[RNYChick2013 10]

I had my surgery in two. I was so very upset but glad afterwards. I had lots of scar tissue and my band wasn't connected either! I had RNY surgery 3 months later. My recovery was not a walk in the part (RNY) either, but I wouldn't trade this journey for anything. I am as pleased as punch. Had RNY in Sept 2013 and down 70 pds

[curlyRNYgirl999 2]

Update: My new surgeon Dr. Kelvin Higa is going to do just one surgery. I had no problems with the office at my new surgeon getting insurance approval. I wish I would have gone to them from the start! I just got the call today that I am scheduled for January 29th! I cannot wait! It has been quite the journey to get here but I am so glad to be moving on from the band!

[R@VEN 27]

Curly. I'm interested to hear how it went. Congrats

[EricNYC 0]

Hi everybody. I have a band that slipped twice. It's been 11 years since my original surgery. I lost over 100 lbs and have gained it all back now. This second band slipped. I have been in pain my stomach is above the band now. My surgeon said we should take it out and do the bypass preferably in one surgery. We put in the request over a month ago to bcbs and I still have no word. They are aaying that because of all the snow in the northeast they have been backed up on cases. Ohhh did I mention my dr put it In as an emergency. Help. What do I do??

[EricNYC 0]

Yay. It was approved. All of it.

[Doer 14]

I had the band out in November, and the RNY in February - two surgeries. My doctor would not do them together, but he did admit me for the band removal in "emergency" to assure my insurance would cover the removal.

My bypass took him about an hour and a half longer than what he says is his usual because of scarring from all the problems I had with the band. After reading what other people have posted here, I wonder if maybe I also have a bigger pouch due to the band. That would explain why I still feel hungry and why I don't feel restricted at all.

[revision in TX 38]

I would not have wanted to do two surgeries, but now that you are through them, it doesn't really matter how you got to this point...only that you got here.

Yes, your pouch is most likely bigger than "the norm"...because of adhesions/scar tissue from your band/removal...my surgeon told me that it would be...upfront, so it wasn't a surprise.

Keep in mind, though, that with RNY you don't (generally) have as much restriction as a band, but you have the added effect of malabsorption, which is a second method for weight loss. That's why RNY is done, to give BOTH methods as tools for losing whe the band (restriction alone) is not enough (or you have complications, like reflux, hiatal hernia, slippage, etc.).

Trust me, there will be times when you are THANKFUL that your pouch is a little bit bigger...there will be times you'll want to eat a little bit bigger "special meal" that you would not otherwise be able to enjoy. And, you're still going to lose weight...probably much better than with your band. Just keep doing what they advise and it will all turn out fine!

My biggest "difference" is that I cannot eat much sugar AT ALL, unless it is in VERY SMALL quantities...but isn't that part of the reason for RNY in the first place? to reduce sweet tooth splurges??? I feel very fortunate, because now I can eat a piece of chocolate (or a couple bites of cake) etc and enjoy my favorites WHILE STILL LOSING WEIGHT! You'll find how much you can tolerate by trial and error (the error being you feel very full and very sick to your stomach)...for me, I can have a two-bite brownie, about 6-8 M&M's, or 2 squares of a Hershey bar and I'm ok. Mind you, I need to have it separate from my meal (or I'll get too full) and with NO OTHER sweetness at the same time (ie, drinks, fruit, etc.)

Also, just a little PLUG for Kelloggs hot cereals (oatmeal type)...I CAN eat one of those for Breakfast (whereas I could not eat Quaker's version...something like 34 g. carbs/sugar compared to around 12 for Kelloggs'. I can even have the maple & brown sugar...again, as long as no other sweets at/near it!!! I love all three flavors and eat one every morning for Breakfast, unless I have eggs.

Watch any granola bars, fruit bars, etc. for the carb/sugar content. For me, no more than about 8-12g or it will make me sick to my stomach (which I think is a good behavior modifier!!)

Just what has worked for me. Best wishes in your WL journey!