One Surgery or Two?

[curlyRNYgirl999 2]

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??

[Harleychic13 11]

I had one surgery to remove the band and have the bypass. The doctor said the only reason to have two would depend on scar tissue or any other issues once he got in there. I would not want to go through two surgeries unless absolutely necessary. I have BCBS and had no issues with approval. Good luck and don't let them jerk you around!

[oldoneyoungagain 200]

My doctor wouldn't do it in one either and I believe for two reasons. My band had slipped, so definitely could have had a problems with weakness in the area of the stomach and second scarring. I didn't mind, removal was done at 3 PM and was home by 5:30 PM and didn't even use pain meds. Ten weeks later had bypass, ended up with very little scar tissue inside and doctor couldn't believe how well I was doing the next day as I'm 71 and was out walking his other patients. Was ready to go back to work the following Monday, had surgery on Wednesday. But went ahead and took two weeks off. I'm glad I waited as felt it gave the stomach some time to heal. But that is my opinion.

[reshiapooh96 31]

There are 3 surgeons in my clinic. My Dr. will not do it in one procedure, she told me that's the way she was taught to do it but the other 2 surgeons will do it in one procedure. I'm like you and want it done in one, but I really don't care about having it in 2 surgeries if it's safer for me. She said we could wait and do RNY 6-8 weeks later. My first surgeon wanted to wait 6 months.

[curlyRNYgirl999 2]

I suppose it doesn't matter either way. I just don't feel like they are being honest about the reason for having two. Especially since the surgeon himself wanted to do it in one. I will put my request forward for the one surgery and if it gets denied then I have everything already done to request it in two. Either way, this band is coming out.

[iamworthit 208]

I had it in one surgery. But my doctor did warn me that it could take two. They don't always know until you're opened up. I had my revision at mayo clinic and trust them completely. I was so happy they were able to do it in one surgery and extremely glad to be done with the band. I hit 175 this morning and feel fantastic!

[reshiapooh96 31]

I had it in one surgery. But my doctor did warn me that it could take two. They don't always know until you're opened up. I had my revision at mayo clinic and trust them completely. I was so happy they were able to do it in one surgery and extremely glad to be done with the band. I hit 175 this morning and feel fantastic!

I hope to make that same statement before and after my revision. what was your weight before revising, and when did you have it done?

[SoccerMomma73 1,867]

My surgeon does it in one but warns you it may be two. Tada! I was two....I cannot imagine what right an insurance company would have to say that it has to be 2 surgeries though...I think I'm with you in calling BS! Good luck!!!

[iamworthit 208]

I hope to make that same statement before and after my revision. what was your weight before revising' date=' and when did you have it done?[/quote']

I was 220 on the day of surgery (6/12/13) and am 175 as of today. The lowest I ever got with my band was 180. I am not a fast loser but at least it is coming off. I am thrilled with the results so far.

[Dara Levy 8]

I'm having one surgery. Sounds like you should talk to your doctor and have him straighten out your staff. If that doesn't wOrk, though may want to switch surgeons. My first surgeon was so incompetent he let me suffer with a slipped band for nine months. Then changed the band but it right. The second one made me wait forever and didn't fix anything. I am now at the best hospital with thee head of the department and am having surgery December 6th. So I believe just through the process I had to go through you shouldn't settle for bs. You need to be completely confident in your surgeon. Best of luck to you.

[malijah1383840067 2]

My dr would only do it in 2 surgeries. I begged for one. He said he feels the stomach needs time to heal for the bypass to go as smoothly as possible. ( plus he's not the dr who put it in) I had my band removed OCT 15 and he plans to do the second surgery in JAN. He said I had a lot of scar tissue and my bypass pouch may be slightly bigger than a virgin stomach.

[Dara Levy 8]

Many doctors share your doctor's opinion. Mine is willing to do it all in one as long as everything looks good. This will be my third wls. If things don't look good., she's just taking the band out and I'm done with wls.

[elli'smommy 160]

I have Anthem BC/BS and mine was done in one surgery. Doc advised it could take two but I never really had any issues with my band (the doc that installed it ruptured it during a fill so it never worked for me) like erosions, pain, or slippage; so I guess that helped out. I will say new doc had to make my pouch a little smaller than he usually does but Ive had no issues with that either. Best of luck.

[curlyRNYgirl999 2]

Spoke to the pre-authorization review folks at Anthem BC/BS today and they told me that the cpt code for the band removal was denied but the code to do the bypass was approved. Say what? Hmm...waiting for the doctor office to call me and see what they say. Anthem said they probably just need to adjust their coding for the request. At least I know what insurance said before the doctor's office if they try to tell me differently.

[curlyRNYgirl999 2]

So an update today...the doctor's office is officially full of B.S. I am switching offices now. Despite all of my efforts to speak with insurance and them and get this all sorted out they are standing on the side of money, delaying my care and compromising the health of other patients who aren't as willing to question them.

I am actually not mad about having to switch because the other Surgeon's office I have chosen is one of the best in the state and is very well known for its patient care and follow-up care. It still digusts me though that some WLS Offices out there are just looking to manipulate and take advantage of desparate people in need. I should have known when they first charged me a "program fee" but offered no additional services to justify it as well as having a 1-800-blah blah THIN phone number. Ugh. I feel so stupid for chosing them in the first place but glad the agony is over.