Hi guys,

Last year i tried to see if I could get approved for surgery. The suregons office called me back and told me that my insurance required 5 years of medical history showing obesity. Unfortunately, i have not gone to the doctor every single year. i dont have any medical issues other than knee and back problems, and some cholesterol.

I dont have the money to pay out of pocket (not even sure how much this would cost, but i'm guessing its more than 20K for the sleeve). so i just gave up....

its been on my mind again for weeks and decided to call a different surgeons office and have them check my insurance again. they called me back a few hours later to tell me that I was covered and to schedule the first appointment. I asked her what are the requirements from my insurance and she told me they want 6 months supervised diet.

Thinking this was kind of strange that the requirements changed, I decided to call my insurance and ask them myself. I was told that i was covered and when I asked what I need to provide, I was told that I would need to provide the medical records with payments. asking her to explain what that meant, she kept on saying "submit all the medical records provided bu you doctor with payment receipts"

I have no idea what that means... Does anyone? i might call again tomorrow or monday if they are closed tomorrow and try and get a better explanation. But just thought Id ask and see if someone might know what that means.

I have moved A LOT in the last 10 years (3 different states, 2 different countries, 6 or 7 moves total, so it is hard to keep track) and have seen a few doctors here and there, and have tried to contact the ones I could remember. One in 2015 had my correct weight, one in 2012 did not write my weight down... all it shows is that i came to see him that day, and he ordered some blood tests because i had not seen a doctor in a while. so yea.. that is really all i have right now. I saw a doctor in 2013 but it was at a walk in clinic, but I am not sure they keep a record or not, but will try to find out what the name is so i can call them..

If my insurance doesn't cover it because i need the 5 year history. is it legal for me to find a new insurance and sign up on my own that will accept and cover the surgery with less requirements? and if so, what is the best insurance to get that will cover it?

thank you so much!

I have BCBS of Alabama and I had to provide 3 years of medical records to prove that I had been overweight for 3 years. All I had to do was sign a medical release and that information was sent from my PCP to the surgeon office so that can submit it to the insurance company.

With the lap band I had GERD. With the Sleeve I have GERD. I don't think that BCBS Federal will cover the Sleeve to RNY revision because of GERD. Do you know?

Last time in 2014 my doctor's office requested for me the revision surgery the Sleeve to RNY revision BCBS Fed denied me because I was non compliant according to my Sleeve Surgeon's remarks on my record. Also, I had my Sleeve in 2009 and did self pay cause BCBS Fed would not cover the Sleeve.

I wonder if something has changed in their policy now to allow revisions from a Sleeve to RNY because of GERD. I have notice a few people here saying that BCBS Fed covered their revision from the Sleeve to RNY because of GERD.

My weight is just like it was before the Sleeve. 190 lbs. and I'm 5'1".

Hi lykapal, I was wondering what your reason was for getting the RNY? I too have BCBS Federal. I had the LB surgery in 2008, hated it and the weight I lost I gained back, BCBS Fed did cover it. In 2009, I had a revision from the LB to the Sleeve. BCBS Fed did not cover it, I was self pay. The reason was because I was not in compliance according to my medical records. Just because the VSG surgeon wrote on my record that I would eat when I was stressed out and go for the wrong foods. The sleeve was just not what I expected it to be for me not enough restriction and I guess I needed the malabsorption the RNY has. I have had severe acid reflux because of a Hiatal Hernia that I have had since 2008. I wake up in the middle of the night with acid reflux and am so tired of it. I am hoping that BCBS Fed will cover the RNY for me. Especially because I hear the RNY doesn't give people Hiatal Hernias. I REGRET HAVING THE LB AND THEN THE SLEEVE

Hi lykapal, I was wondering what your reason was for getting the RNY? I too have BCBS Federal. I had the LB surgery in 2008, hated it and the weight I lost I gained back, BCBS Fed did cover it. In 2009, I had a revision from the LB to the Sleeve. BCBS Fed did not cover it, I was self pay. The reason was because I was not in compliance according to my medical records. Just because the VSG surgeon wrote on my record that I would eat when I was stressed out and go for the wrong foods. The sleeve was just not what I expected it to be for me not enough restriction and I guess I needed the malabsorption the RNY has. I have had severe acid reflux because of a Hiatal Hernia that I have had since 2008. I wake up in the middle of the night with acid reflux and am so tired of it. I am hoping that BCBS Fed will cover the RNY for me. Especially because I hear the RNY doesn't give people Hiatal Hernias. I REGRET HAVING THE LB AND THEN THE SLEEVE.