Will insurance cover revision due to GERD if WLS is excluded?

Gwen M.
on 9/27/18 10:23 am
VSG on 03/13/14

The subject line sort of says it all.

I've been having acid issues and I've got a follow-up with my surgeon scheduled for Oct 16th. This seems like an on-going thing at this point for me and I know that the most plausible fix action is RNY.

However, the employer I currently have health insurance through excludes everything relating to weight loss. (******s.)

Since I wouldn't qualify for WLS now anyway, and the RNY would be solely for GERD, are they likely to cover it? Have any of you had this situation where WLS isn't covered, but surgery to rectify GERD is?

Ultimately I'll ask my insurance about this when I get there, but I wanted to know what other people's personal experience was on this.

VSG with Dr. Salameh - 3/13/2014
Diagnosed with Binge Eating Disorder and started Vyvanse - 7/22/2016
Reconstructive Surgeries with Dr. Michaels - 6/5/2017 (LBL & brachioplasty), 8/14/2017 (UBL & mastopexy), 11/6/2017 (medial leg lift)

Age 42 Height 5'4" HW 319 (1/3/2014) SW 293 (3/13/2014) CW 149 (7/16/2017)
Next Goal 145 - normal BMI | Total Weight Lost 170

TrendWeight | Food Blog (sort of functional) | Journal (down for maintenance)

ljbarbara
on 9/27/18 12:12 pm

When I was revised from the sleeve to RNY due to GERD, I did not need to lose any weight.

I was approved after the 24 hour ph test and manometry test verified severe GERD. This also "proved" the surgery was for GERD relief and not for weight loss.

My insurance does cover bariatric surgery, but again, because this was not weight loss related they would have covered it in any event.

Best of luck to you and, btw...My GERD is now gone post RNY!

Original surgery: VSG Feb. 2009

REVISED TO RNY FEBRUARY 2016

Height: 5'7"

Start weight: 252. Current weight: 120

Gwen M.
on 9/27/18 12:12 pm
VSG on 03/13/14

Awesome, that's reassuring!

VSG with Dr. Salameh - 3/13/2014
Diagnosed with Binge Eating Disorder and started Vyvanse - 7/22/2016
Reconstructive Surgeries with Dr. Michaels - 6/5/2017 (LBL & brachioplasty), 8/14/2017 (UBL & mastopexy), 11/6/2017 (medial leg lift)

Age 42 Height 5'4" HW 319 (1/3/2014) SW 293 (3/13/2014) CW 149 (7/16/2017)
Next Goal 145 - normal BMI | Total Weight Lost 170

TrendWeight | Food Blog (sort of functional) | Journal (down for maintenance)

stacyrg
on 10/1/18 6:02 pm
VSG on 05/12/14

Late to the party, but I think mine was the same way. It was not coded as a bariatric procedure. But it's hard for me to say for sure, because my insurance covered WLS.

As you know my GERD is not 100% gone, but it is significantly better than it was with my VSG.

Gwen M.
on 10/2/18 9:08 am
VSG on 03/13/14

What are you doing to manage your remaining GERD now?

VSG with Dr. Salameh - 3/13/2014
Diagnosed with Binge Eating Disorder and started Vyvanse - 7/22/2016
Reconstructive Surgeries with Dr. Michaels - 6/5/2017 (LBL & brachioplasty), 8/14/2017 (UBL & mastopexy), 11/6/2017 (medial leg lift)

Age 42 Height 5'4" HW 319 (1/3/2014) SW 293 (3/13/2014) CW 149 (7/16/2017)
Next Goal 145 - normal BMI | Total Weight Lost 170

TrendWeight | Food Blog (sort of functional) | Journal (down for maintenance)

stacyrg
on 10/2/18 11:56 am
VSG on 05/12/14

Right now I take daily PPI. We're going to try and do the Stretta procedure to see if that gets me to 100% resolved.

It is much improved.

Gwen M.
on 10/2/18 12:23 pm
VSG on 03/13/14

I'm glad it has improved!

VSG with Dr. Salameh - 3/13/2014
Diagnosed with Binge Eating Disorder and started Vyvanse - 7/22/2016
Reconstructive Surgeries with Dr. Michaels - 6/5/2017 (LBL & brachioplasty), 8/14/2017 (UBL & mastopexy), 11/6/2017 (medial leg lift)

Age 42 Height 5'4" HW 319 (1/3/2014) SW 293 (3/13/2014) CW 149 (7/16/2017)
Next Goal 145 - normal BMI | Total Weight Lost 170

TrendWeight | Food Blog (sort of functional) | Journal (down for maintenance)

Gonnabskinni2018
on 10/29/18 9:12 am

Please update once you do your Stretta procedure. I would like to know how it works for you I have been looking at it.

stacyrg
on 10/1/18 6:03 pm
VSG on 05/12/14

Late to the party, but I think mine was the same way. It was not coded as a bariatric procedure. But it's hard for me to say for sure, because my insurance covered WLS.

As you know my GERD is not 100% gone, but it is significantly better than it was with my VSG.

Jester
on 9/27/18 12:21 pm
RNY on 03/21/16 with

This is a really interesting topic that I don't recall coming up in the past. Please make sure to keep everyone posted as I'm sure your experience will be useful to others. I had an RNY initially (partly do to existing GERD issues), but I'm still very interested in your outcome. Best of luck!

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