Revision covered but no longer Morbidly Obese..Just regular Obese?

I posted this over on the INS board no answers as of yet. I'm posting here because most of you had revisions already.

I have BCBCMI-PPO. They told me that it is covered as long as I get a letter of necessity from my Dr. One of the Dr's offices called back and told me that I have to gain 10-15lbs  because I have no co-morbids and wait until Jan due to the Dr. is booked out. Has anyone gotten aprroved with just a letter of necessity from your Dr just due to the lap band failed? I really don't want to gain any weight at this point. I am going to call another Dr's office to see what they  say also.

My bmi is 35.5-36 I'm 5'7.5  btw 220-230lbs.  I told the Dr, office I was 230lb

Honestly -  you need to get your ins plans  coverage  info ,  revisions are normaly covered for a few differant reasons, You just need the criteria - IT is O.K. to call and ask for it , Plus if you do have to wait to new year - your ins may change ??

I agree with what Gina said. Call your insurance and ask for the exact criteria for a revision. I did, and my company sent me a website, with everything I needed to know. I have BCBS of GA PPO and turns out thay they do only require a letter of medical necessity due to mechanical failure of the first surgery. I think I'm submitted for approval, and I'm just waiting now.

Thanks,
Jill

Thanks I am calling now to get the exact criteria needed sent to me or emailed.

We're in the same boat....my insurance covers WLS (this is my revision), but I, too, and 5'7" and 230 and not MO anymore (was 390), so I thinkw we're putting the highest weight of 250 on my info.  PS- had the Band put on my RNY pouch (tiny pouch, huge stoma) and it does do anything by make me barf.  The band is now NOT considered to be an effective revision tool.....do he DS or extended RNY. 

 I too have BCBS of MI PPO.  I had called for the requirements and was told a couple of different stories.  Jen for Dr. Schlesingers office also called and got different stories as well.  We finally got the story.  Here is what I was told as requirements for the plan I have;

1. Date and type of previous wls
2. The factor(s) the precipitated failure
3. Complications from previous surgery
4. It can not be due to the failure of the patient to loose all the weight they originally wanted

Here's the kicker....If you choose to stay in MI then they will give you pre authorization.  What I ran into was much what you did when it came to MI doctors.  They wanted me to gain more weight.  I simply refuse to gain more weight just to submit for an approval I am not guaranteed to get.  2nd, while there are some very good surgeons in MI, not many of them have a lot of revision experience.

So...I decided that revision experience is very important to me and I wanted a doctor who took my concerns as a patient into consideration and understood why I do not want to gain weight to have a surgery to loose weight.  I ended up choosing Dr. S in AZ.  Now here is what the kicker is with the BCBS of MI...  They WILL NOT give me a precert for going out of state.  They only say that my plan covers revisions if they are medically necessary and that I am covered!  What's up with that!?!?  So I am going ahead with it knowing there is risk.  I will appeal if necessary but feel very confident with the abilities of Dr. S's staff to help me get the approvals I need.

Good luck to you.  I hope all turns out well.

Mew, Thats what I got from bcbs today. The exact same thing you have up there. I'm scared mine may not be covered due to no mechanical failure.

Well so far it has been worth it for me to travel out of state for this.  Of course ask me again in 2 weeks when I am back in MI after my surgery...

I have BCBS PPO/EPO National and my doctor's office sent over 63 pages and they almost didn't approve me.  Luckily Carol who does the approval is wonderful and talked to them and got it approved.  I've been having all sorts of issues and had to do an endoscopy, colonoscopy, nutritional visits, another pscyh eval, primary care note, and an esophogeal studay.  I bring food & beverage up at least 12 times a week and have already been unfilled.  I'm still down 100 lbs but am bordering between obese and MO.  

Good luck with your approval and don't give up, keep sending them info til they approve you.