Denied for revision GHI Help!!!

I didn't have a problem with my revision because my band was causing me to vomit a lot (I got stuck a lot) and PB a lot, and reflux a lot.  Also, I had a boat load of comorbities, just like you do. 

Fight fight fight!!!

Hi there.

Most important thing I can tell you is DO NOT GIVE UP!

I didn't have to have a revision, but I did have to fight for THREE YEARS to get approved for my surgery originally.

One time I was denied because the psychiatrist who did my psych exam wrote in his letter that I needed to wait a year first. (He also didn't bother telling ME that! I had to find out later.)

The second time I was denied because of my 6 month long diet. I had visited my doc at the end of the month every visit. One month I had to reschedule my appt and so I had it on the first of the following month. I was denied for surgery because, on paper, it looked like I'd skipped a month!

I am not joking at all. They will deny you for the slightest reason.

I kept going, though, and finally got approved on my 3rd try. I had gone thru 3 psych evals, 3 different diets of 6 months long each, and 3 different seminars for 3 different surgeons. I had the Duodenal Switch, and I have lost an amazing 133 pounds in just 7 months!

Please keep fighting. Do not let them get you down or make you quit. I kept fighting and it finally happened for me. I'm just as happy now as I would have been if I'd gotten the surgery on my first try, but even more so. IT WILL BE WORTH IT IN THE END!

Please consider the Duodenal Switch. Did you know that when Gastric Bypass patients need a revision done, it's the DS that the surgeons do??? You don't wanna have to have a 2nd revision; go for the best now.

Just my humble opinion... hahahah!

Keep fighting! It's worth it!

Barbara

So sorry your going through this! The Lap Band does not seem to work for most ppl. That is why I am always going on here and warning ppl about it. I hate for them to waste the time and money on a WLS that statistically WON'T work long term..............and a lot of times even short term! :-(

As others have mentioned, I think with a BMI of 60 that DS would be the best choice.

If you go to my WLS website I do have an article on there with info about insurance appeals:

http://www.formerlyfluffy.com/bariatric-surgery-insurance-appeal/

Hopefully there will be some info in there that can be helpful to you.

Don't give up on the appeal, and whatever you do............DO IT QUICKLY! A lot of insurance companies are starting to add a "one WLS per lifetime" stipulation, so if yours does not have it now, your lucky, but they could start it at any time.

Good luck!

Thanks Maria I apreciate your help.I just wish they wouldn't paint such a rosy picture with this band.Everyone I had the surgey with is in the same boat.It just doesn't work.My doc does the DS but I can't get approved for the revision.I'm hoping the peer review will go well tommorow.Having constant fluid on my brain is really taking a toll and I need help losing this weight.Thanks again

UPDATE!!!

My doctor did a peer review with GHI and they overturned my denial.THANK GOD!!They have approved me.Thankyou so much for all of your kind words.I'm so grateful to Dr.Brathewaite and his staff they really went to bat for me.

I am so happy for u! Keep us updated on the revision. :-)

What is a peer review?

Peer review is when your doctor speaks directly to the doctor at the insurance company.He lets them know why it is necesarry for a revision.In my case I had psuedotumor ceribri and could barely function anymore.He was able to have my denial overturned.Thank God