WARNING TO PRE-OPS: Think twice, cut once -- or else!

As someone who helps people get insurance coverage for the DS, I am also seeing more and more people looking for REVISIONS to their first bariatric surgeries which failed them -- almost always the VBG, VSG, Lapband or RNY.

More and more often, people are showing up with a new contractual limitation in their health insurance which often turns out to be insurmountable:  a one-bariatric-surgery-per-lifetime restriction.  Yes, even if a different insurance company paid for your initial surgery, or even if you SELF-PAID for your first surgery.  Basically, the insurance company is excluding ANY revision surgeries, except possibly to reverse the surgery altogether if there are medically necessary complications, e.g., to remove a bad band -- but they won't pay for a revision to another surgery.

THINK TWICE, CUT ONCE -- YOU MAY NOT GET A SECOND CHANCE!

Make sure you really understand the true benefits of the DS before you opt for a less-effective surgery.

thank you diana, for being brave enough to look out for pre-ops!

My question is... how do you know if there is such a restriction on your policy?   I am not even begining to think of a revision.... but was just wondering how you know?   I mean... I read my policy and every little bit that it had on the coverage for WLS... and my policy only gave a choice between RNY and Band.   It did not cover DS. I did not have a large choice.  I did not want the DS, but I understand that it is becoming more and more popular and may eventually replace RNY as the gold standard of WLS. 

I kind of think that this rule sucks because what if a surgery does not work for you?   At the support group I go to, there is a guy who had surgery a few years ago.   He had one surgery and was thinking of changing to something else because for some reason.... it did not work for him.   I dont know why, but he still weighed like 400 lbs.  I dont know why it did not work, but by observing him ... he does all the right things. Maybe he is a closet binger and we dont know... but my point is what ever he did, didnt work and if necessary, he should be given the chance to change it.  I guess if he is self pay he could... but still.... kinda unfair to him I guess. 

Mine says it right there in black and white.  A once in a lifetime chance to have the surgery.  The end.  That's all, folks!

You are not getting my point.  It is not the insurance policy you have NOW that matters -- it is the fact that there is a growing trend to include the one-bariatric-surgery-per-lifetime limitation in all insurance policies that I am warning about.  When you need a revision, are you going to be able to get one?

"What if a surgery does not work for you?"  My point exactly!  This is why you MUST chose the bariatric surgery that has the highest likelihood of working for you THE FIRST TIME.  YOU CAN'T ASSUME that if you have a surgery that is sold to you as being "less invasive" or "less drastic," e.g., in comparison with the DS (the lies that the RNY, VSG and Lapband surgeons tell), and that if it doesn't work, you can get a revision to another surgery. e.g., the DS.

You may have only one shot at getting insurance coverage for bariatric surgery.  Make sure it is one that is going to work.

Oh.  I guess mine does not have that on it.   Because I looked for any possible reason they could deny me... so I read it cover to cover.   :)  Anyway.   I am not looking to have it revised anyway... not a problem for me anyway.  :)  I love my RNY. 

Your CURRENT policy may not have that limitation, but what about the one you have in two years?  Five years?  The insurance companies all go along with each other's money-saving good ideas, just like the airlines do with fare hikes.

And who is going to complain?  Surely not the other non-MO insureds who are already outraged that they have to pay for even ONE surgery to fix our fat asses.  They are going to agree that limiting coverage to one surgery is GENIUS.  And totally fair.

Buyer beware.

But , policies change every year..i think is the point being made.  What you have now, is not guaranteed to stay that way.  Just important for people to consider.

Precisely.

I had the last small-company (under 50 employees) WLS coverage policy available in WA. It cost a bundle and I had to hand massage every claim, sore throat, labs, mini, mighty, whatever. BUT, if we had a complication (think bowel obstruction or some such thing for long terms), it woulda had us covered.

My season runs Oct to Sept, and we had it for one full year and then in JULY of the 2nd year, they dropped WLS coverage. Poof. Just like that. Mid contract. Seems to me a contract is a binding agreement between 2 parties. Um, one of us was not bound, apparently. But that's state of WA, for ya.

So, while it's great that ppl have coverage that doesn't exclude stuff TODAY, it could change at the drop of a pen stroke. And you do not get a vote.

I'm back to the best policy I can get in this state as a small busines (BCBS), BUT the wt loss (of any kind) exclusion has grown from 3 sentences to 3 PARAGRAPHS.

"I love my RNY"..

I am not trying to down your surgery or your love for it.  I hope it works well and always works well for you.  But as a revision from RNY to DS...... I would be neglectful to any pre-ops if I didn't point out this fact.  No-one realizes they have the need for a revision in the first year..it is after you'v-e had it for a while and don't lose all your weight or regain that the need for a revision comes into play.  In my case, it was almost 2 years to the week that I felt my staple line disrupt.  I was 117 lbs when it did.  Up til then, I, too. loved my RNY.

When I took the desperate measure of having a revision, I weighed 259 lbs.  Again.  This is why it's of paramont importance to choose the right surgery the first time.. and to me that means the surgery with the best odds for lifetime weight control.

Just sayin'..