Requirements?

Can anyone tell me what the requirements are to have a revision done? I am just starting to check into this. I have BC/BS PPO of Michigan. Thanks in advance for any info. Connie

Usually same NIH guidelines, however having ventral hernia or other surgical needs. I had a vertical Banding done in 1992, and have a surgery date of August 14, 2006. Just waiting on final approval from pacificare insurance here in CA.

What do you mean by NIH guidelines? I was just denied by BCBS for my revision which was scheduled next week. My policy covers the treatment of MO including surgery. I had 6 months supervised diet with my PCP. I have actually been seeing my surgeon who will do the revision for over 18 months. I have a hernia that was going to be repaired at the same time. I still weigh 300lbs, down from 502, 462 pre-op 3 years ago. But stop losing after 1 year. My pouch is way to big and my stoma is too big. BCBS said not medically neccesary. Since my original surgery I have had a DVT, nonWLS related and 2 mini-strokes...only risk factors now for future strokes is my weight and I am only 28. I have never weighed less than 300, followed protocol...actually was stalled at 330-340 for 2 years and recently took off the extra in preparation for this surgery...felt like I was starving myself. Have NEVER had the quickly full feeling. I called BCBS to asked what their requirements for a revision were...not like my surgeons office hadn't gotten them before we proceeded and we thought we had met them....but anyway no one could give them to me...said case by case. But what they told my surgeons' office was the reason for the denial sounded like they were denying a reveral...said unless I had malnurishment or rapid weightloss a second bypass wasn't deemed neccessary...something just isn't right.

Hi Sarah, Just got back Friday from Boston, Ma.. I had the endoscopic gastric bypass repair by Dr. Christopoher Thompson and believe me it works, I am losing more weight now than I did 3 years ago with my original RNY. Since Tuesday I have lost 14 pounds. He does the revision endoscopically and is the only doctor to do this procedure in the country. I have Independent BC/BS of Pennsylvania PPO and they will not pay for a revision, only one bariatric surgery in a life time but they did pay for this procedure, it is not considered a surgery. I am having problems with Brighams Womens Hospital because of the codes they use, they use codes that show some type of morbid obesity surgery and I was denied the hospital payment, the hospital said they will do a promissory note and I can make payments, I am still going to try and fight the hospital or the insurance to get some proper codes If I can be of any further help let me know. I had s stretched pouch and stretched stoma and he did my stoma very tight and left the pouch because he said he did not know what my origianl doctor was thinking and his tools are beoing shipped to him in a couple of weeks, I have a very thin cylinder pouch, that stoma tightness is the most important I think.

Do you know what the cpt code is for the stomaphyx

Hi Constance, I have BC/BS of IL PPO. They require a 12 month Dr supervised diet and all kinds of other things. I did not want to wait the 12 months. I am going self-pay. I have checked and my Dr. is the lowest cost that I have found. I have checked several states. He is also one of the best Drs. in the country. If you need more information, just email me. Hope this helps.

hi I too have bcbs and no matter what I do can't get it covered. they say only i surgury but they never pay for the first. but they will fix conplactions but I have a stomach line brakdown, stomach infection, enlarged liver, pain and epigastric pain, and trouble brathing, just got the letter back from the appeal and they said no no extenuating cir****tances to make this med. necessary.

I was just approved for a revision and the only requirements I had to give was a list of diets I have tried either on my own or supervised. Since I am only 5 years out from having the gastric bypass I was still considered under medical supervision. So id this helps, getting approved for a revision will be just like taking the same steps as you did with your first surgery.