Revision under BMI 40???

I had my surgery 11/03. Started at 5'0 205lbs. Open RNY (proximal). Went down to 89lbs (I know, too skinny) BUT since then, I'm back up to 165lbs. I have Fed BC/BS. Is there anyone here who had a revision under 40 BMI and/or anyone who got Fed BC/BS to pay for it? In 2003, they wouldn't precertify DS because it was still considered "experimental" - any updates on this?!? Also, that stoma tightening in Boston - is that covered by insurance? Any info. would be greatly appreciated - we all have to stick together!!! Thanks alot, Jennifer

Jenneifer, Your insurance company may approve your revision if you have health problems. I also have Fed BC/BS and I am strongly considering a revision. I had the mini-gastric by-pass 6 years ago and I did lose as much as I thought I would and I have regained. So I know how you feel out there.

I do believe I heard somewhere that medicare has dropped the "experimental" status on the DS. Good luck!

I have AZ BC/BS HMO and they cover revision if any 1 of 20 conditions exist - for example: failed weight with weight regain due to stomal (pouch) dilation, failed weight loss with esophageal dilation, severe GERD, pouch enlargement. Meeting the other critera - BMI, 6 - 12 mo. medically supervised diet, psych evaluation and all the other hoops are NOT reguired. Call your insurance company and ask for the medical coverage guidelines/criteria for bariatric surgery. My insurance sent the guidelines to me in 2 days - by law they have to provide this upon reguest. As far as the stoma tightening in Boston - I read from anther post that the cost was about $6,000 + cost of pre-op consult and of course related travel expenses if you don't live in Boston. The surgeon is booked to Nov. I believe he's the only surgeon doing this so you can bet the insurance companies would consider it "experimental" and not cover it. Get the insurance code from the doctor and call your insurance co. to see if it's a covered procedure. Hope this helps. Debbie

Thank you so much for your replies - the support is fanstastic! - Jennifer Smith

I just had to send a note because we have similar beginning stats. I'm 5ft tall also and 206/207. I'm in the early stages of getting the DS and my insurance does cover it and I was worried it would not (I have PHCS). I am so excited about all I've read about the DS in comparison to other WLS. I don't know much about revisions but I do know that more and more insurance companies will cover the DS but the tricky part is there are not as many doctors who do the DS as opposed to other WLS. In Minnesota, there are only 3 who perform it but luckily in my area. Good luck with everything!