Anyone get DS (original or revision) approved with Fed BC/BS?

I just posted a few days ago, but in a nutshell - I had open proximal RNY 11/03 - gained 50% back, but still under 40 BMI - looking into a revision, but here's my Q: When I originally went for the RNY, Fed BC/BS would not precertify - my BMI was 39 and I took my chances. Thankfully, everything worked out (I spent months with them over this, and they said they do not precertify ANYTHING). Now, I'm looking into the DS, and in 2003, BC/BS considered it "experimental". Has anyone gotten this surgery approved/paid for after 2003? Would it be easier to get an approval for a revision to the DS (even though my BMI is still under 40)??? Thanks again - I have a PCP appt. Monday ~

Hey Jennifer! I'm sorry had such a rough time with your weight loss. I was a self pay but I'm sure there are quite a few people who can help you with information on the DS boards http://www.obesityhelp.com/forums/DS Also there is a not for profit DS board that has a section dedicated to insurance it is the name of the surgery (what DS stands for) dot com. In case that infor gets deleted the site that I mentioned is easily found by googling the name of the surgery (what the DS stand for) Best of luck!! Nim 281/156/130

Hi - I also have federal health insurance and it is my understanding that they are required to approve this surgery as long as you meet their requirements for "medically necessary" revisions. I have federal aetna insurance and was approved for my original RNY in 2 weeks and my revision to DS in about 3 weeks. No problems. Now what their requirements are ahead of time and get all your ducks in a row. I can't imagine them saying they will not pre-approve - that would make me nervous. Call and check on that because different reps will tell you different things. I had federal Blue HMO at one time and they definitely pre-certified everything. It's too their advantage so you are getting care at facilities they've already made arrangements with Anyway - good luck and come visit the DS board if you are looking for any further DS information.

Hi,Jennifer, I just saw this post today, so I'm a little late on a reply. I had a revision from a VBG to a DS 1/4/06. I have Highmark BCBS and they did not approve the surgery. The old "experimental" excuse! I went to Dr. Ungson in Mexico and paid for it myself. Today is my 6 month anniversary and I have lost 85 lbs! Good luck with your attempt to get your Ins. to pay! ANN