xt aetna revision questions

 i was wondering if anyone had any insight on aetna approval for revision. the clinical policy bulletin for obesity surgery for aetna indicates that repeat bariatric surgery is approved if after 2 years less than 50% of excess weight has been lost and/or there has been stretching of the stoma or pouch. I just qualify under the first requirement. i originally lost 80pounds of the 110 i needed to lose and have regained approx 30 so ive only lost 50 pounds which is just under the 50% of excess weight loss so inmy mind, i qualify. my BMI is currently 35 and I have people telling me that I will never be qualified for repeat surgery unless i have co-morbidities. I am going for an upper endoscopy which will show if there has been stretching. i guess my question is this, i cant find anything that indicates that i have to have co-morbidities with a bmi of only 35 for a revision. i know that was definitely the case for an initial surgery. im thinking I should qualify under the requirements that I am able to find. i havent had the endoscopy yet but would be willing to bet money that there is some major stretching. i have searched and scoured and when i call aetna they simply refer me back to my summary plan description and the clinical policy bulletin for obesity surgery. any insight or experience out there? im just afraid to jump through all the hoops (cardiologist and ekg,sleep study,3 months nutrition, upper endoscopy,ab ultrasound,psych eval.,pulmonologist etc) and then be denied for something I didnt know about.

No insurance guru here. I'm thinking some of the DS vets on Proboards might know. Let me know if you need that link. I think if you post your questions on the main board there you might get some opinions.

--gina

if you type something like "atena insurance revision approval" you will find others who have posted this question and see the answers they got. (in the search option)