Just Denied

Thanks. I haven't been very attentive.

Yes.

I'm sorry. Our insurance system is horrible. Over the years, more and more policies drop WKS coverage altogether, and others have instituted a one surgery per lifetime rule.

The exception that comes up often, though, is a revision for medical, not weight loss reasons. Many bands get taken out and revised to another surgery because of medical necessity. VSG is revised to RNY because of gerd. Maybe this is an approach you could pursue?

Don't give up yet. I was denied my revision 4 times before they finally agreed to pay for it. I think insurance companies count on people giving up. I had a paper trail of my complications a mile long and was ready to give an hours long presentation to them. You may have to be aggressive with the insurance company.

Do you have any mechanical failure of your VSG? Do you suffer from GERD? Do you have a hiatal hernia or a Peterson's hernia? Are you having problems with keeping food down or extensive pain? Is your sleeve misshapen in any way? Do you still have any co-morbidities like diabetes, high blood pressure, etc. Any of these could be a reason for a revision and should be looked into.

If you are not having problems with your original surgery, they may not approve a revision. At that point you would have to look into self pay.

I'm so sorry. Definitely appeal - you have nothing to lose.

I wonder if they could re-word the request as a complete revision instead of the 2nd part of DS? It's worth a try, right?

I'm so sorry this happened. Our health system in the US sucks. I would try to appeal, painful as that may be. And if you are ultimately unsuccessful, contact Dr. Esquerra at Mexicali Bariatric Center as he's one of the best DS surgeons in Mexico and is highly regarded. Self-pay is not ideal but if you go that route you can save money and have a great result with MBC.

Start the appeals process, but also start journalling to prove the issue of why you need the revision, if it is GERD, mechanical issues with the sleeve, etc. Also, start the appeals process NOW. AND, become a royal pain in the insurance company's keister! Trust me! I've done this before.

As for the snarky comment, please ignore it! That is one of the reasons I haven't been on here as often lately. I deal in snark all the time other places, but there is no need for it here. This is to be a place of support. I understand that sometimes we need the cold, hard truth, but really!! If you can't say something nice, don't say anything at all. AND, before someone starts with me, there is a marked difference between telling someone something that they don't want to hear and being nasty about it!

I think most of the regulars on the board know to ignore Ava.

I agree very mean comment but I don't think she even realizes sometimes what she is writing is not nice to say. Some people lack tact. No excuses but what I have come to believe from past posts.