REVISION 6 month medically supervised weight loss??

If an insurance company requires a 6 month medically supervised diet prior to covering a patient's FIRST bariatric surgery, do they also require it for revision?

I own a local small business. I'm currently shopping for group health policies, so I can't simply call my insurance company... I'm selecting our policy mostly based on my need for a revision (from lapband to DS). My current individual policy doesn't cover bariatric surgery.

I'm comparing United Healthcare, Kaiser and BCBS Ga at the moment.

I've seen them require all kinds of things. And surgeons have ADDITIONAL requirements.

If you are lucky enough to find a policy that covers revisions, grab it. They are rare. And more and more have a one WLS per lifetime exclusion. Even if another insurer covered the first surgery. The 6 month diet wouldn't bother me at all in light of all the other obstacles.

If you are working with a broker, as to see the policy you are planning to buy or access to the web site to see the details, the same way you would get access to check if your current physicians are in network or your meds are on the pharmacy formulary.

I Googled United Health Care individual policies and bariatric surgery and turned up this

https://www.unitedhealthcareonline.com/ccmcontent/ProviderII /UHC/en-US/Assets/ProviderStaticFiles/ProviderStaticFilesPdf /Tools%20and%20Resources/Policies%20and%20Protocols/Medical% 20Policies/Medical%20Policies/Bariatric_Surgery.pdf

Which may provide some guidance for your decision. You don't say what state you are in - if you are buying on the exchange, reach out to a navigator to help you - they are out there and do not charge.

Good luck.

You may already know this, so I apologize if you do, however I would talk to very experienced DS patients and suss out the name of a surgeon skilled at doing lapband to DS revisions. It is a much more complex procedure than the standard DS, (already complex and delicate in its own right), and it may have tobe done in two parts if there is significant lapband damage. Maybe not, however you absolutely want the best of the best. Dr. K comes to mind, as does Dr. Prachand. Both have probably done thousands of revisions each, never mind DS surgeries. Those are two examples of several.

I mention this because 1) you may have to travel and 2) it may be more beneficial to find the surgeon *first* and then work backwards and find out what insurance they take, all other policies aside.

The "good" news is that lapband revisions are the most common these days, and it's far easier to get approved (at least here in Illinois) from what I've seen, then to, say, revise a sleeve to a sleeve for a lack of weight loss. Many bands have to be removed regardless for errors and damage.

I would consult the DS forums if you haven't already, though. Many very knowledgeable people there who could appropriately direct you.

Ditto on what Donna said, you want a surgeon that has done "a lot" of DS procedures and if it's a revision that adds another layer of complicated procedure. Let us know if you need help finding a surgeon once you get your insurance lined up

I second (or third) the motion to shop for a surgeon first. While a band to DS revision is not as complex as an RNY to DS job, you still want a guy who knows his way around a potentially damaged (from the band) stomach. When you have things whittled down to a top two or three choices, talk to their insurance coordinators about your situation and get their perspective on which company is the best choice - these are the guys with the most experience in these matters. Most of the information you seek should be somewhere in a company's online policy bulletins - not always easy to wade through, but again, the insurance coordinators can help with this.

Generally, if an insurance company requires a pre-op weight loss program for a first WLS, they generally will also require it for a revision. HOWEVER, if your revision is due to complications of the original surgery rather than regain or inadequate weightloss, the rules may change, from both pre-op requirements and lifetime WLS limitation perspectives, as it can then get categorized as treating those complications rather than a basic WLS, even if it is the same basic procedure.