Revision Insurance Question, specifically Highmark BCBS

MsDeniseinPA
on 1/8/08 10:51 am - PA
hi! I went to a WLS seminar tonight as required by the surgeon I'm wanting to work with on my revision.  As we arrived, the insurance specialist gave us a handout specific to our individual insurance carrier with required procedures and documentation, procedure codes etc.  I have Highmark BC/BS PPO Blue and right on this handout it states "Revision Surgeries are no longer covered by Blue Cross/Blue Shield for Weight Gain. Has anyone recently had a revision with this insurance? if so, how did you get around it?  one of the offices requirements is that we all call our insurance company to see if the different surgeries are covered under our plans (they gave us the diagnosis and procedure codes) before we move forward...so I know if I call and say I want to know if a revision is covered, I'm going to be told no.  I don't want to just ask about the specific procedures without mentioning a revision, because I don't want to have to go through the other requirements (Upper GI, U/S of gallbladder, nutrition consult, supervised diet for 6 months) if in the end I"m going to be rejected ... the insurance specialist said that not all revisions are denied, it's only denied if the only reason is due to weight gain, so if there are medical issues necessitating the revision or open staples etc. (I had a VBG in 1998), etc, the revision surgery might  be approved....so I need to know the right terminology to ask when I'm contacting the insurance company. anyone with any experience in this that could help me out?  
darnell239
on 1/8/08 7:42 pm - Columbia, SC
My first advice would by have an upper GI and see if there is a mechanical failure to your surgery.  You had the VBG and that surgery tends to have a lot of staple line disruption see if there is a problem with your pouch.  If there is than it will help with insurance approval.  That's all the advice I can offer.  Good luck!
Most Active
×