Insurance Question about Revison

I am trying to get a revision done, went to William Overcash and he told me I needed a complete revision.  I will have more intestions taken out, stomaphyx for pouch and stoma. My insurance said they covered the revision, I had the insurance code and called the insurance company before I made the 3 hour trip.  After the doctor put the necessary paper work through  for an approval, I was denied, the reason was Administrative, I received a letter today they changed it from Administrative to Medical Necessity.  Has anyone gone through this type of appeal and how did it come out?  i was so excited when I called with the insurance code and they said yes it is covered and now i have to go through the appeal process.  By the way my insurance company is Independence Blue Cross Blue Shield of Pennsylvania (Personal Choice).  Self Insured company. Any information you can give me will be helpful.

I had BC/BS PPO approve my revision....I had a LapBand placed on my pouch. My pouch was still tiny, but my stoma was ripped open. I had it done last November. I haven't lost jack **** I haven't gained either, but a revision was to uhh...LOSE weight. I am not happy since I wasted my revision. I had to appeal, too. My surgeon had to write a letter AND have a teleconference with the approval board to say it was medically necessary or my weight regain would start to cause serious medical problems. I went from 390 to 220 and had my revision at 261. I am currently 20 weeks pregnant, but at my first pregnancy/ob visit I was 268...so I actually gained after my revision. My last appointment at 18 weeks put me at 262, so I'm basically where I was last November. Research carefully and make sure the revision you are choosing is going to work since you will probably win your appeal, but can only get surgery covered again one more time. I would be careful about removing more intestine. I have MAJOR iron absorbancy issues now and have to have IV iron infusions weekly for a series of weeks at a time. I also had to have another psych eval (paid out of pocket) and show I had attempted to lose weight for the last 6 months---thank God I had asked for diet pills (Phentermine) about 4 months before.

Hi Paula, Thanks for the input, it all helps.  I have studied and what I really want is a DS.  What can I do since I have already gone to Dr. Overcash, he does not do the DS surgery.  Do I need to start all over again.  I know so many people have problems with the Rouxny and gaining weight.  Good luck with you have a heallthy baby. You said you can have 2 revisions is that  correct?  I went back to a doctor who specializes in eating disorders, been going to her about 4 months, that should help also.

hi! ?, revision on a kaiser patient? I had cigna when I did open RNY? Do U think that is possible?? Thanks for your f/u in advance :)

Donna, I was told the exact same thing by Dr. OverCash.  I talked with him over the phone told him my previous surgery was the mini gastric bypass and I was interested in the stomaphx and he said because of the type of surgery I had I need a revision.  What rational did he give you for needing a complete revision?  My insurance is Federal BC/BS and they approved my revision within one week.  However, I am still interested in why you were told a complete revision vs a stomaphx?

He said I needed the total revision due to my prior surgery not giving me much of a tool to work with, They gave me a 50cc pouch and I am distal with the intestines, he said I needed to be more proximal. My pouch is very large now and the stoma is very open.

Donna, I still don't follow the part about you being distal and he wants to make you proximal.  I thought that distal meant bypassing the largest amount of intestines.  It seems he believe you should not have alot of intestines bypass.  I wonder how many other people he has told they need a complete revision vs the stomaphx?

I am so sorry, he wants to make me distal, and he does want to do the stomaphyx rather than going open.  he will only need a small incision to make me more distal.  Hope I didn't confuse you tomuch.