Revisions and insurance?

I have had the lap-band in 2004 and have had nothing but problems with it ever since. I really want to have a revision from lap to RNY but the ins. (BCBSGA) denied it. Has anyone gotten approval for revision surgery?

I am in the same boat. Trying to get a revision approved from a lap-band to an RNY with Empire Blue (BC/BS out of New York).  Can you tell me why they denied it? I am assuming that you are still morbidly obese? Doesn't that automatically qualify as medically necessary?

Yes still morbidly obese. The reason for the denial was really unclear to me. This is what they wrote "for revision of gastric restrictive procedure for clinically severe obesity, there must be documentation of a failure secondary to a surgical complication such as fistula, obstruction or disruption of a suture / staple line." Anyway that was the most of it, but I am just not understanding I had nothing but obstructions when I ws filled. Anyway where are you on your revision journey?

I am just starting. I see the psychologist this week as well as having a second dietary appointment. My fear is that if they are going to deny the revision, they will not cover the $300 psych eveal or any of the $185 dietaries. My issue is that when I get to good restriction I develop GERD and aspiration. My concern is that they will not consider this "a failure secondary to a SURGICAL COMPLICATION". I think that is they key here.

My insurance covered all the prelim testing. You can always check your insurance coverage and see. I am allowed so many psyc visits a year.

Look in your handbook to see if you are only allowed one WLS per lifetime.  If nothing is mentioned, then check to see if you can download the BCBSGA policy online.  It should give you specifics.

Thank you for your help.  My policy doesn't say anything about that and I meet all the requirements. So now I am just waiting on the Dr to file an appeal.

Hi, I just added a post at the top on revisions.  Let me know if you have any other questions after reading it or suggestions.