need a revision to revision
I found out that I need a revision to my revision. I need this not because I need to lose more weight but because my body is not absorbing enough protein and is life threatening. I was already in the hospital a year ago because of it and had a PICC for 3 weeks until my levels got back to where they needed to be. The news gets worse because of the new insurance my husband's work picked because of Obamacare, bariatric surgery is now excluded. Is there anyway around this?
I am no expert but it seems like the surgeon could bill this as some code other than WLS - since you are having malabsorption issues. Have you asked the surgeon this question? My employer doesn't cover WLS but a co worker had a life threatening complication from the lapband and insurance covered to have it removed.
I am am having a really hard time getting protein shakes down and am concerned I could end up with similar problem. I am 8 weeks post op.
Would you mind sharing more of your story? Are you able to eat protein? Do you do shakes? When did the problems start? Do you have a short common channel?
Thanks!!!
Thanks everyone, but my wls doctor is the one who called me to tell me I was denied because it is considered bariatric surgery. I knew we were switching insurances the next month. He said to make sure they don't have bariatric excluded. Of course it is, my luck. I can't imagine that after I appeal that it won't be covered. I am in the same mindset as all of you, this is not wls. This is to save my life. I was already in the hospital for 3 weeks on and off last year and then had a picc for a month to build my levels back up. My levels are going back down again. In answer to your question, yes I do have a short common channel. That is exactly what he wants to fix. He wants to make it slightly longer. Mine was apparently to extreme for my body. Everyone is different. As far as the amount of protein I need a day to maintain, it is 130. That is a lot. You can only get that amount with shakes which of course I don't like but do force myself. I am ready to start fighting this battle with insurance, I would just feel better knowing I am going to win. The alternative is scarey. Also I have no money to pay for it out of pocket and have lousy credit. I do have a huge hernia they have to cover to fix and I have the extra skin around the belly that they want to remove at the same time, which I am sure will also be a fight but at least that isn't life threatening.
That's right. I don't think the insurance would consider this bariatric surgery (even though its' a result of bariatric surgery). They might not even consider your WLS as pertinent since it is over 3 years ago. Ask the surgeon about using different codes. IT seems to me that it is a treatment for a deficiency.
I hope insurance works out for you.
Pete
This isn't bariatric surgery. Your surgeon's insurance staff should know what codes to use. Maybe something about malabsorptive condition, or malnutrition, or some such thing. That's why surgeons have employees who deal with insurance. It's medically necessary care and you should be able to have it covered.
Larra
what others have posted is correct, this is not bariatric surgery, this is medically necessary treatment due to malnutrition, and since it is medically necessary, this should be covered, I think your dr's office is not understanding the issue correctly, and not coding it correctly. and if you have been denied it is your right to receive the reason why you were denied, what was originally requested..etc...something doesn't seem right here.....keep looking into it
Ok everyone, it may not make sense but lengthening my common channel, although it will save my life is considered bariatric and my insurance will not cover it no natter what. Good thing I have 401k. In about a month I am gong in for hernia repair paid for by insurance, tummy tuck and revision paid for by me.
