Requirements for Revision to RNY? On Medicare?

LisaLoo
on 4/10/16 8:20 pm

Hi everyone.  I had RNY surgery in August 2004 and initially lost 140 lbs.  However, since then I went through cancer treatments.  Right before I was diagnosed with cancer, my weight started creeping up due to stress.  During chemo, it plummeted from the chemo, because basically I didn't eat anything for 5 months!  Now, I am sorry to say that I am really struggling and my weight has creeped up to the 200 lb. mark.  I am trying to cut back and exercise but I just keep yo-yoing.  I am frustrated because I seem to be able to eat a lot more than I used to.  I would like to have the lap band revision (I think?) to the original RNY. 

I have 3 questions:  1. are the requirements the same for a revision as they are for the initial wls, i.e, BMI and co-morbidities?  2. Does anyone know of a reputable wls in the Tampa area; 3. I am still on Medicare due to the cancer, but I am only 53.  Does anyone know what the medicare policy is for a revision for people UNDER 65?

Thanks for all of your help!

NYMom222
on 4/10/16 8:47 pm
RNY on 07/23/14

I think what you are talking about is called band over bypass.

I don't know anything about the revision, but in the mean time why don't you spend some time over on the RNY Board. Maybe look at the what are you eating today posts... Might help you get back on track...

I was on Medicare in my 30's at one point due to disability... I never remember any changes in policies with it due to age....

Cynthia 5'11" RNY 7/23/2014

Goal reached 17 months. 220lb Weight Loss
Plastic Surgery Dr. Joseph Michaels - LBL and Hernia Repair 2/29/16, Arm Lift, BL, 5/2/16, Leg Lift 7/25/16

#lifeisanadventure #fightthegoodfight #noregrets

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LisaLoo
on 4/10/16 9:22 pm

So, just for clarification on my post ... I need information about insurance requirements for a revision and any guidance on revision options for rny patients and if possible recommendations for surgeon in my area.

I am eating way more than I usually do and am hungry ALL OF THE TIME.  I am considering a visit to a wls surgeon to see if something is going on physically with my pouch and if so what my revision options are. I expect that the doctor will want me to work with the dietician to look at my diet because obviously it is my diet. There are a lot of things going on with my body due to all of the drugs I have had to take in the past few years, one of them being Lyrica which caused me to gain 40 lbs in six weeks. I have been struggling since then even though I am off of the drug. I am currently taking a hormone inhibitor and it is possible that it may be the culprit but I can not go off that drug. 

Pleeeeeze don't lecture me about diet, because I can't handle that right now.  I kept the weight off for nine years. I ran 3 miles a day and lived on about 1500-1800 calories all of that time and was content so I can assure you I know what to eat and what to do. 

I don't want to waste my time seeing a wls surgeon if I know in advance that I am not going to qualify for a revision so I am asking for a little guidance on that topic and possibly a ray of hope. I hate the way I look and feel at the moment and I just can't seem to get my body back on track.  Thx.

ladygodiva1228
on 4/11/16 8:11 am - Putnam, CT
Revision on 02/04/15
On April 11, 2016 at 3:20 AM Pacific Time, LisaLoo wrote:

Hi everyone.  I had RNY surgery in August 2004 and initially lost 140 lbs.  However, since then I went through cancer treatments.  Right before I was diagnosed with cancer, my weight started creeping up due to stress.  During chemo, it plummeted from the chemo, because basically I didn't eat anything for 5 months!  Now, I am sorry to say that I am really struggling and my weight has creeped up to the 200 lb. mark.  I am trying to cut back and exercise but I just keep yo-yoing.  I am frustrated because I seem to be able to eat a lot more than I used to.  I would like to have the lap band revision (I think?) to the original RNY. 

I have 3 questions:  1. are the requirements the same for a revision as they are for the initial wls, i.e, BMI and co-morbidities?  2. Does anyone know of a reputable wls in the Tampa area; 3. I am still on Medicare due to the cancer, but I am only 53.  Does anyone know what the medicare policy is for a revision for people UNDER 65?

Thanks for all of your help!

No one on here is going to be able to tell you what the requirements for revision WLS is since all insurance companies are different.  Some require the same as the original surgery and some do not.

I would call Medicare directly and ask them.  That way you know 100% what is required.

Also, I wouldn't get the band over bypass.  I had the band for over 10 years and was just revised a year ago to the bypass. The band does un-reversible damage.  I had to have a small section of my stomach where my band was completely removed due to the damage.

 

 

 

 

Dr. Sanchez Lapband 9/12/2003
hw305/revision w280/cw197/gw150

Revision from Lap Band to Bypass on 2/4/2015 by Dr. Pohl

    

LisaLoo
on 4/11/16 9:27 am

Thank you so much for your guidance. I am sorry to hear about the problems you are having with the band. I remember now why I didn't go in that direction originally.

Hislady
on 4/11/16 9:08 pm - Vancouver, WA

I agree with ladygodiva I had my band removed (no revision) 2 yrs ago and have nothing but horrible GERD and stomach pain from scar tissue left by the band. i would look at the Apollo overstitch method of tightening the pouch before I would do the band over bypass. I don't know for sure if that is covered by medicare or not but it is worth asking about. Good luck!

Kathyjs
on 4/11/16 3:32 pm

Were you ever in the weight loss chat room? I had surgery 13 years ago and remember your name from someplace. I am sorry you are going thru so much. I wish I had an answer but you will have to contact Medicare directly, hugs 

LisaLoo
on 4/11/16 5:00 pm

Hi Kathy!  Yes, I was.  I relied very heavily on all of the help and support I received from this board back then!  Thank you for remembering me! Hugs back!

 

miscemails
on 4/22/16 10:40 am

Was wondering if you ever got an answer to your question about Medicare covering a revisional weight loss surgery. Did you speak with Medicare? Thank you and best of luck.

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