Changing my mind between sleeve vs bypass

[BlahAndMore 5]

I know I should probably talk to my doctor, but has anymore changed their mind on which weightloss surgery to have? I have one more step left on Monday before everything is submitted to insurance for approval.

I chose the sleeve 7 months ago when I had my 1st and only appointment with the Bariatric surgeon - I only entertained the surgery initially as a less invasive procedure compared to back surgery per my primary care dr. However, after completing the 6 month dieting for insurance purposes and learning about my eating habits, how my body responds, etc., and by doing a lot more research, I strongly feel Bypass will be better for me in the long run.

My question is will I have to start this whole process over, although it hasn't been submitted to insurance yet?

[catwoman7 11,212]

I would be shocked if you had to start the whole process over if it hasn't even been submitted to insurance yet. Even if it HAD been submitted to insurance, probably the worst that could happen would be a slight delay (although even that would surprise me...)

[BlahAndMore 5]

Hi catwoman. Thanks for your reply, and for your reassurance. I've been thinking about this for a while, and I've basically reached this decision today, on the weekend lol.

I guess I'm also nervous that my surgeon won't agree as he seemed pretty confident about the sleeve. I know I'm usually not really ever satisfied after eating a normal portion of food and I "feel" hungry soon after and that I crave sweets regularly. I need more help with my hunger pangs.

[RickM 1,747]

Amongst all the paperwork that you sign with the surgeon is probably a form where you approve him to make a decision on the fly as to which procedure is best once he gets inside you - sometimes they find some obstacle to doing a bypass and will do a sleeve instead (or vice versa, though that is more rare.) Of course, one can not sign that authorization if one really wants a bypass and absolutely not a sleeve (or vice versa,) but then you wind up being sedated and going into surgery and having nothing done. So, a change in procedure once bariatrics are approved is not a big deal.

[ChunkCat 728]

When we submitted to insurance we weren't sure which procedure we were going with (the doctor needed to talk to my gastro doc) so we just submitted for the bigger procedure (DS), knowing we could downgrade if needed and insurance would be easy to run through again. I don't think you'll have much of a hold up unless the doctor doesn't do the bypass surgeries? Congrats on deciding which surgery is right for you!!

[New To This23 102]

Just talk to your doctor at the next appointment and let them know you would prefer to do a bypass, the doctor will let you know if they think you are a good candidate for it, and then it should be no problem, even for the insurance. I am getting the roux-en-Y bypass for those same reasons you stated and because I want to lessen my chance of revision, one and done with surgery is what I said to the doc and he said I get it.

[BigZ 102]

My surgeon recommended starting with the sleeve, and then at a later date it can be revised (if needed). If you start bypass then the sleeve would do no good.

[BlahAndMore 5]

Hi all. Thank you for the kind responses! I wrote my doctor a lengthy email expressing my desire to change surgery types, and he was fine with it.

[BlondePatriotInCDA 494]

On 10/21/2023 at 2:39 PM, BlahAndMore said:

I know I should probably talk to my doctor, but has anymore changed their mind on which weightloss surgery to have? I have one more step left on Monday before everything is submitted to insurance for approval.

I chose the sleeve 7 months ago when I had my 1st and only appointment with the Bariatric surgeon - I only entertained the surgery initially as a less invasive procedure compared to back surgery per my primary care dr. However, after completing the 6 month dieting for insurance purposes and learning about my eating habits, how my body responds, etc., and by doing a lot more research, I strongly feel Bypass will be better for me in the long run.

My question is will I have to start this whole process over, although it hasn't been submitted to insurance yet?

My surgeon gave me up to a week before, asking just to make sure I was comfortable with my choice. The surgeon gets prior authorization for WSL ...and can change options mid surgery if they feel its a better option for you. So, I don't foresee it being an issue for you to change.

[rootsbeforebranches 8]

On 10/23/2023 at 12:37 PM, BigZ said:

My surgeon recommended starting with the sleeve, and then at a later date it can be revised (if needed). If you start bypass then the sleeve would do no good.

While this is true, it's important to keep insurance in mind unless you're in a position to be able to afford the surgery out of pocket. Initially, I was going to do a staged DuoDenal Switch but after reviewing my insurance-- turns out they would not cover a revision. Both my surgeon and I agreed that it would be much better to go with Roux-en-Y if we had to choose between the VSG only or the RNY only.

[ChunkCat 728]

On 11/10/2023 at 2:37 AM, rootsbeforebranches said:

Initially, I was going to do a staged DuoDenal Switch but after reviewing my insurance-- turns out they would not cover a revision. Both my surgeon and I agreed that it would be much better to go with Roux-en-Y if we had to choose between the VSG only or the RNY only.

I think some get around this by having their insurance approve the staged treatment plan ahead of time, that way it isn't considered a revision, it is considered the second step in a primary surgery. This happens most often when a person's weight is high enough the surgeon believes the intestinal part of the surgery will be easier and safer at a lower weight. I've seen a number of people do this on the DS groups so it is possible, but my guess is not every insurance company lets their patients know it is possible and I'm sure there are some that outright refuse to because insurance companies like to be difficult. I wish you much luck with your surgery!!

[rootsbeforebranches 8]

On 11/13/2023 at 4:06 PM, ChunkCat said:

I think some get around this by having their insurance approve the staged treatment plan ahead of time, that way it isn't considered a revision, it is considered the second step in a primary surgery. This happens most often when a person's weight is high enough the surgeon believes the intestinal part of the surgery will be easier and safer at a lower weight. I've seen a number of people do this on the DS groups so it is possible, but my guess is not every insurance company lets their patients know it is possible and I'm sure there are some that outright refuse to because insurance companies like to be difficult. I wish you much luck with your surgery!!

Insurance companies are arguably the worst. My BMI is high enough (approx. 70) that both my surgeon and I strongly felt that the DS was the best way to go. My surgeon consulted his colleagues and they felt it was appropriate to stage the surgery for safety but when my patient coordinator reached out to insurance, they said they would not cover the second stage. So I'm facing RNY on 11/30, despite my greater need for the DS.

Such is life, I suppose. I just wish that if your surgeon says you need something, insurance doesn't have a right to say otherwise. Thank you for the luck, I'll take all I can get! 😅

[ChunkCat 728]

17 hours ago, rootsbeforebranches said:

Insurance companies are arguably the worst. My BMI is high enough (approx. 70) that both my surgeon and I strongly felt that the DS was the best way to go. My surgeon consulted his colleagues and they felt it was appropriate to stage the surgery for safety but when my patient coordinator reached out to insurance, they said they would not cover the second stage. So I'm facing RNY on 11/30, despite my greater need for the DS.

Such is life, I suppose. I just wish that if your surgeon says you need something, insurance doesn't have a right to say otherwise. Thank you for the luck, I'll take all I can get! 😅

I fully agree with you!! I have other medical conditions that have required treatment insurance has decided not to cover. Not for any good reason, just because they don't feel like it! I think one of the greatest tragedies in the US healthcare system is we let insurance companies make medical decisions that are supposed to be made by doctors and their patients. No corporate entity should be able to override my doctor when it comes to what I need for care. But, that's what you get in a capitalist society that thinks healthcare is a privilege. 🙄

If it is any consolation, there are a number of RNY patients on here who have lost an amazing amount of weight, DS levels of weight!! My doctor said that the sleeve usually takes off the weight, while the intestinal bypass in a RNY or DS is what keeps off the weight long term. You will still be getting some of that in the RNY. I wish you so much good in your journey!! Please keep us posted!

[rootsbeforebranches 8]

On 11/17/2023 at 11:45 AM, ChunkCat said:

I fully agree with you!! I have other medical conditions that have required treatment insurance has decided not to cover. Not for any good reason, just because they don't feel like it! I think one of the greatest tragedies in the US healthcare system is we let insurance companies make medical decisions that are supposed to be made by doctors and their patients. No corporate entity should be able to override my doctor when it comes to what I need for care. But, that's what you get in a capitalist society that thinks healthcare is a privilege. 🙄

If it is any consolation, there are a number of RNY patients on here who have lost an amazing amount of weight, DS levels of weight!! My doctor said that the sleeve usually takes off the weight, while the intestinal bypass in a RNY or DS is what keeps off the weight long term. You will still be getting some of that in the RNY. I wish you so much good in your journey!! Please keep us posted!

THIS ^ alllllll of this! It is truly unbelievable how these companies make life or death decisions about people they've never even met before. Sickening, really. 😔

That does make me feel a bit better that RNY patients here have had DS-level successes. I felt for a long while that I couldn't let myself be excited because it wasn't the switch but this gives me hope. Truly, thank you. ☺️

[ChunkCat 728]

12 hours ago, rootsbeforebranches said:

That does make me feel a bit better that RNY patients here have had DS-level successes. I felt for a long while that I couldn't let myself be excited because it wasn't the switch but this gives me hope. Truly, thank you. ☺️

I'm so glad it helps, you deserve to be excited!! I believe @The Greater Fool and @catwoman7 both were near your starting weight, catwoman7 was 373 and I'm not sure what The Greater Fool was but I know they say they were too heavy for a home scale. Both had Gastric Bypass and did exceptionally well! I also have a friend who lost about 250 lbs with an old school bypass and maintained it for over a decade when I knew her... You've got this!!