Denied twice for a revision... wondering how much $$ out of pocket to revise to DS

KyleBeth
on 4/3/11 2:55 am - Erie, PA

Hi everyone,

For the past 3 years i've been trying to get approved for a revision.. I've been denied twice because the insurance company has said it is not "Medically Necessary". My docotor disagreed and did a peer to peer review, wrote a 5 page summary of how my first surgery was done incorrectly and what he would do to fix it. Even after a peer to peer review with the medical director of my insurance company, it was denied. My surgeons office then said they could do nothing more to help, and that I could presue approval on my own... I have no idea where to even start.

I was wondering how much i'd have to pay out of pocket to get revised from RNY to DS. I know it's a very risky procedure and that only a handful of doctors do it.

I don't know what to do... any advice would be appreicated!

Thanks,

Kyle

ckb70
on 4/3/11 5:44 am - Morrisville, PA

VSG on 04/12/11

Sorry for what you are going through. There are a few people on this site that have made a point to help people who have been denied for revision.

Please PM DianaCox and she if she can help you! (I only know her by some of her post and not personally)

Good luck!

No longer a slave to hunger!

flucca
on 4/3/11 8:35 am - Fort Lauderdale, FL

VSG on 08/06/10

I hope you can get this approved, they should have to cover it if you can document medical problems. How did they determine it is not "medically necessary"? Would you qualify for wls based on your current bmi? or do you need revision for reasons other than regain. I actually got approval not only for revision but also to go to Canada. Either way, I would put Dr. Gagner in Montreal at the top of your list. He is one of the few surgeons in the world capable of doing this revision laproscopically. He also has one of the lowest self pay rates. I beleive it's about $17,000.

smileyjamie72
on 4/5/11 7:35 am - Palmer, AK

DS on 12/29/11

I was down from Alaska, and saw Dr. Keshishian in California, and roughly it is $28,000.00 including the hospital.

I have the actual paperwork at home, I can get it & give you the actual #'s tomorrow.

-Jamie

RNY 2/26/2002                           DS 12/29/2011
HW 317                                     SW 263 BMI 45.1
SW 298                                     CW 192 BMI 32.9~60% EWL
LW 151 in 2003
TT 4/9/2003

Normal BMI 24.8 is my GOAL!!!

GBP (RNY) 2/26/02 298 lbs, TT 4/9/03 151 lbs, DS 12/29/11
HW 317 SW 263 BMI 45.1/CW 192 BMI 32.9/GW 145 ~ Normal BMI 24.8
**Revision Journey started 3/2009 Approved 12/12/11**

KyleBeth
on 4/5/11 8:31 am - Erie, PA

RNY on 12/22/05

Jamie that would be great!

Thank you :)

My husband told me i'm crazy and that there is absolutely no way i'm going to CA for surgery... He still hasn't learned that when he tells me no that just means i'll absolutely do it :)

smileyjamie72
on 4/7/11 1:38 am, edited 4/7/11 1:38 am - Palmer, AK

DS on 12/29/11

Surgeon Fee: $11,000.00
Hospital Fee: $17,500.00
Plus **Program Fee** $4,000.00

I also posted a separate post with this.
-Jamie

RNY 2/26/2002                           DS 12/29/2011
HW 317                                     SW 263 BMI 45.1
SW 298                                     CW 192 BMI 32.9~60% EWL
LW 151 in 2003
TT 4/9/2003

Normal BMI 24.8 is my GOAL!!!

GBP (RNY) 2/26/02 298 lbs, TT 4/9/03 151 lbs, DS 12/29/11
HW 317 SW 263 BMI 45.1/CW 192 BMI 32.9/GW 145 ~ Normal BMI 24.8
**Revision Journey started 3/2009 Approved 12/12/11**

Denied twice for a revision... wondering how much $$ out of pocket to revise to DS

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Denied twice for a revision... wondering how much $$ out of pocket to revise to DS