Should I get a second opinion?

So I am wondering if I should get a second opinion from a different surgeon. Mine isn't sure the insurance will approve my revision even though I do have Gerd and Barrett's Esophagus and gain. But he said we still have to do the entire process including another psychological

evaluation And three months of the nutritionist. My question is this is that standard even with the revision?

Getting insurance to approve revision is hard....even with legitimate reasons. When I first started with my surgeon she explained that insurance companies shelled out TONS of money for bariatric procedures, and coming back and asking them to approve a revision to another surgery because the first one failed (for whatever reason) almost always results in an automatic 'no'.

For my revision, it took a year and a half of working towards it. I had to prove that I was compliant with the lap-band, I lost the weight when I followed the rules. My insurance judges someone as compliant if they lose something like 50% of their excess weight and I had lost 55%. I had to prove that my band was a problem - had an endoscopy and proved that GERD was causing problems....so they approved the removal portion no problem. But...I then had to fulfill the requirements that a first-timer would have to do to try and get them to approve the Revision portion. I went to the classes, I saw the RD, I saw the psych for a clearance, I had what felt like a bajillion bloodtests, x-rays, ekg. I tracked everything and had the apps and log-books to prove it. We literally overwhelmed them with data on how compliant I was.

It was hard, and sometimes frustrating....and my approval took longer because BCBS switched from requiring 6mos of data to 12mos. of data and even though I had started my journey to revision under the 6mos requirement they wanted 12mos.

Each insurance is going to be different - but ultimately yes....it's likely you are going to have to jump through all those hoops if you want the insurance to cover your revision.

Approval for my revision wasn't hard in the slightest. It was approved a day after submission. I did not have to do another psych evaluation, nor did I have a waiting period or a pre op diet. My surgeon had me attend 1 pre-op class since I needed to follow his post op progression and, as he said, a refresher couldn't hurt.

I don't know what a different surgeon would do for you if the requirements are imposed by your insurance company, which they very well may be. If they're imposed by your surgeon, I guess whether you seek a second opinion depends wholly on your comfort level with your surgeon and his program. I happen to love my surgeon and if he made me jump through hoops before revision, I would have done it.

But to answer your question, I did not have to do anything other than to show that the revision was medically necessary, which in my case it was.

What insurance do you have?

My revision was approved by Aetna.

I have aetna too so fingers crossed it goes smoothly

Same here. Easy approval with Blue Sheild HMO.

I too had no problem with my revision being approved for bile reflux & the hiatal hernia repair. I was not required to attend the nutritional classes or psych eval. I did have a liquid diet 3 days before surgery.

Wait and see what the insurance says.

Hi Bruindiva92, Which insurance company do you Have? I have BCBS Federal. I also have GERD and a Hiatal Hernia.

I have Health Net through my employer.