Newbie...Hungry for a Revision of VSG to DS

[JRo]

Hello All!

I have been an offsite lurker on a few sites, this one included, for a few months now and felt it was time to finally sign up and to say Howdy!! 

A little about me, I had lapband 10/2009, HW 285, got to about 215 then adjustments stopped having any effect and I had the band removed 5/2014. I then moved forward to the VSG 8/2014. My surgery weight was 266, I got down to a whopping (Sarcasm!) 228 by about December and it's only creeped back up and now at 1 year post op I'm at 252 and beyond disappointed. With the VSG, by the time I was 3 months post op I had almost no restriction and at this point it's as if I had no surgery at all.



I'm now in the process of finding a new surgeon (band, removal and VSG was all with Coirin in Modesto) to hopefully lead me to a revision/DS. I was hoping for Rabkin but my insurance (BSC) doesn't authorize him, so I have made an appointment with Jossart.
However, I have now read quite a few deterrents from Jossart and that he may sway me from the DS and the RNY is not an option for me. Why go sideways or even backwards when I could move forward with the DS. Thats my viewpoint anyway. However, I can't follow through with the full appeal with the DMHC until I meet with Jossart and he does lead me away from the DS. 


Overall, I'm fairly optimistic especially with a new surgeon, and anxious for a final step of success. My primary concern is getting BSC to cover the DS considering my BMI is 42 with minimal co-morbidities (edema, slight sleep apnea, joint pain, lower back pain). Any suggestions or veteran secrets to make sure my insurance gives the go ahead, or if they don't, how to successfully appeal, is most appreciated!

I look forward to lurking (and this time contributing) more and sharing experiences. Any words of encouragement, advice, warnings or howdy' are most welcome!! 

[OnMyWay2Thin]

Welcome, JRo,

I wish you the best of luck and agree with your decision on the revision to the DS. I also had the lapband and had similar results to you. I revised from lapband to DS and it was the best decision I ever made. It's been a little over a year and I am now actually very thin and healthy with the exception of some muscles and a hernia that need fixing.

Good luck with your insurance, sorry no experience with your type. If I can answer any questions for you, let me know. The people on here are great and very helpful. Unfortunately, it's a little slow right now since everyone is out enjoying the weather!

Have a good night,
Kelly

[goodkel]

Welcome JRo!

Since your band has already been removed and you have the VSG, all you need is the switch. You are lucky because any qualified surgeon who does the DS can give you the switch portion.

To qualify for ANY bariatric surgery, all you need is a BMI of 40 or 35 with two co-morbidities. At a 42 BMI, you should have no problem in that regard. Have you read a complete copy of your actual policy?

All I recall of Jossart is that he was a big fan of the VSG and tried to convince people who wanted the DS to get the sleeve instead. But, that was some time ago. Have you contacted him? You should call and make it known that you are ONLY interested in the switch portion of the DS and you are very firm on this. Why waste your time to only hear an RnY sales pitch?

If you can't find a surgeon in network to give you the DS, I believe that they then must approve an out of network surgeon.

But, as far as insurance approval, your best bet is to read your policy and be sure to cover their requirements, or be ready to appeal.

Please keep us informed.

I'm glad you decided to join us.