myth busted about one surgery in a lifetime

I spoke to a bariatric surgery financial counselor at one of our local offices today who said there is no such thing as one surgery per lifetime as some insurance tell us because if the band you have isn't working due to constant revisions or lack of weight loss despite following "the rules"...your surgeon can get your insurance to pay for a GOP revision. However, I did find it interesting when she said that band over bypass was a joke and they refuse to perform it at that office and that if anyone feels the need to get one....they just need to back away from the table.

It's very much an *iffy* thing. They can very well deny it if it's written in the policy. *Sometimes* they will cover a revsion if the band failed. They do not have to do this. What really sucks is that they can deny a revision even if THEY did not pay for the origional WLS!

As far as BOB, I do think it's a joke. It's only going to work temporarily for the most part. just like band only. Now her comment about back away from the table is tacky. True in some instances, but tacky. Some that have RNY don't change eathing habits and regain. With some their stoma stretches,even though their pouch is still smaller. In that case the food is just passing through quickly. :-(

Are you going to be revising?

I would second what Maria says, if it's written into your policy, it isn't a myth and you pretty much would have close to a 0% chance of getting around it. Just like when they have a rider that says "no WLS." If it isn't written into the policy or the language is vague, then you have some room to work on them. You have to examine your plan documents pretty closely.

Re BOB: really ALL WLS have the very distinct possibility of being temporary in the sense that they often do not work forever. Some people with BOB have done quite well. The "back away from the table" attitude in that office is pretty counter-productive, if not rude.

I'm not thinking of a revision at this time. . Right now my weight is too low to quality any way so I was just asking out of curiosity since I kept seeing reports of one surgery per lifetime on a lot of bariatric websites.
Likewise, referring to the backing away from the table comment, that did strike me a bit uncomfortable because folks told me that when I decided to get lap band.

 The "backing away from the table" does seem on the surface to be an insensitive, even cruel remark.. but maybe, just maybe.. they meant back away from the OR Table.   :/  Giving them a HUGE benefit of the doubt here...

 I disagree with both of your comments.  First off, 1 surgery in a lifetime is a REAL clause.  However, if you have a complication, sure they will fix it but they aren't going to revise you from a Band to a DS or something like that.  If you have a band, they may fix your band, etc.

As for the BOB, I find that this "counselor" who isn't obviosuly a medical professional but an administrative assitant who is not qualified to speak on anything other than CPT codes, etc.

Time will tell if the BOB works. I will be a year out next month and I love my Band.  But, 1 year out, I love my RNY too.  WLS is a tool. In 10 years from now, there will be something else that has been discovered and will be the new thing.  Aren't you glad doctors do research and invent new things?  I honestly believe that 50% of the WLS doctors out their doinf procedures today are in it for the buck!  Its the ones like Mitchell Roslin who do research, sit on the boards of insurance companies and develop clinic trials that are the real genuises.  Not this counselor in NC with diahrea of the mouth!

Hello everyone, I revised from band to bypass on 4/25/14. I'm recovering and hoping for the best!