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Hello all,
My revision was denied due to an exclusion. All bariatric surgery is a non covered service. I want to appeal it, and I am wondering if it is even worth the effort. I could ask my HR to add it to our insurance package. However, I really was not planning to tell them about the surgery at all. We do not have an "official" HR person. I work for a non profit, and it is small. Has anyone had luck with appealing an insurance exclusion? Helpful advice only, as in ones with experience. I really do not want comments like "its standard for insurances" or other comments basically stating what I already know. I just really want to know if anyone had any success with this, or even failure.... Just dont wanna hear the ol "I told ya so".
On a much more positive note, I am in the non surgical weight loss program there. Its been two weeks and I have lost 4 pounds! I know it doesn't seem like much, but its a start! Consistency is key! If I can't get approved for the surgery, then I have no other choice but to work hard. These 4 pounds were extremely hard! But I did it!
Are you asking about a revision to your gastric bypass or conversion of you gastric bypass to the DS?
tevision to you bypass, I believe is in the 20-30%.
Conversion to DS is closer to 60-80-%
Greetings All
I seek your advice and experience in trying to decide between the three options-VSG versus RNY versus DS.
Lap Band placed in 2004 and have lost and gained the same 30lbs. I have decided I need to do something about my 48.8 BMI and comorbidities before its too late. Male, 60 y.o.
Thanks in advance for your advice.
Bonvivant57
I have been told that there is a lot of competition for the gastric sleeve done by US surgeons competing with Mexico prices. The person who told me this works for a medical tourism company. He said that surgery has almost become a commodity because it is a rather easy surgery to do. If I recall correctly, he said $11k in the US. I wonder if you call Care Credit if you can ask them for a list of participating bariatric surgeons who accept their payment plan (if that's the way that you wanted to go). I think you also can look on RealSelf for surgeon's costs, although they are much more focused on plastic surgery than bariatric surgery. Otherwise, ask around on this forum and maybe try using the search feature. Or Google search may provide some figures.
I found this on BariatricSurgerySource: The total cost of gastric sleeve surgery without insurance averages just over $19,000, although you may be able to find local gastric sleeve surgery prices as low as $10,000 depending on your region. They got an interactive map that shows which states offer the lowest costs.
I hope this helps.
Living larger than ever,
My Bariatric Life
I have thought of self pay but have no idea how much that would be. Any idea?
I won't go to Mexico.... looked into it in the past but I just couldn't bring myself to do that.
I'm going for my lap band I just finished my requirements and the Office Coordinator says she's sending over my completed folder to the insurance for approval. I had RNY in 2005 I had an egd done and it showed that my pouch has stretched I did my research and decided to have the band done. yes I hear horror stories and I also hear good stories I discussed both with my surgeon and I decided on the lap band. So I hope to be hearing some good news soon that I was approved I'm so ready to get back on track!!!
I have Cigna and they do require 4 dietician Visit one each month and 1 psych evaluation. I just completed them both my Coordinator at the Dr. Office says she sending my folder over to Cigna.
I am so sorry to hear that insurance is so difficult... have you considered going to Mexico for surgery? It's about half the cost as far as I understand it. I am considering doing it myself IF it will heal the digestive disorders that I have been suffering for the past 4 years, because nothing else seems to work and I am desperate to heal.
I know self-pay sucks. I feel like why do I have insurance if they won't cover the medical care that I need... especially after peer review, OMG. But another option in case you have not thought of it is to take out a loan through CareCredit. Some surgeons even offer interest-free financing. So you can self-pay for the surgery in the USA over time.
All of the agonizing, and weight gain, and possibly the cost of therapy and other medical care potentially can be avoided if you just bite the bullet and self-pay is something to consider.
I wish you well with your decision and your approval.
Living larger than ever,
My Bariatric Life
Yes it is a revision.
If I were you I would seek out a surgeon who is very experienced with revisions (has done hundreds at a minimum) so that should be your first question to this surgeon. "how many band revisions have you done?" followed by "what complications did you encounter and how did you handle them?".
I travelled to go to mine. A doctor who has done a lot of band revisions will have experience with dealing with adhesions. Normally a surgeon will remove the band. If the scar tissue is too heavy, they will clean it up and send you home to heal and attempt a revision after about 3 months.
If your doctor cleaned out all your adhesions you are good to go for an RNY. if he didn't, be prepared for your new surgeon to have to do it and then send you home to heal before proceeding with an RNY.
No surgeon will do a revision if you have thick scar tissue, it is because the staples won't hold and that could kill you.
Be very very grateful you didn't get another band again in 2015. You'd have even bigger problems today.
Good recommendations! Can you share the doctor's name that did your revision?
To the OP, I have never met Dr. Roslin at Lennox Hill Hospital in NYC but he did my BF's revision from the band to DS. And he saved her life twice... twice! So I often suggest people look at him when considering revision surgery. I think he only does the DS and even if that surgery is not on your radar I will bet he can offer you good advice. As far as I know, he has an excellent reputation among his peers as a key opinion leader.
Living larger than ever,
My Bariatric Life
I am seeking information from actual people who've had revision to their primary gastric bypass. It is really hard to find information on the Internet regarding this.
One surgeon said 20-40 percent.
One study showed 68%.
And that is ALL that I have been able to find.
Also, did you have any complications? I know the risk goes up with revision surgery versus the primary surgery. Thank you.
Living larger than ever,
My Bariatric Life
