Insurance and revision

Just curious.... do most inurances cover the revision if, let's say, you have a band and it's not working very well and you want to get the RNY or something?  Will they pay for surgery again???

A lot depends on your insurance plan, best way to find out is to call and ask. I have Aetna and they do have criteria to meet. Luckily for me  I was between the 2 instances and they are going to cover it.   But I did call and find out what they take into consideration and Dr Schlesinger  wrote the letter and sent it in, I follwed up with a phone call or two - ot three  and   got the go-ahead this last week !

Sooo, you asked Dr Schlesinger to write a letter for you to the insurance company?  I just got off of the phone with the Insurance person for Dr Nicholson's office and she was not very supportive.  She said she would go ahead and send the paperwork I have forward but that BCBS unless it is like an emergency status that they will reject the revision. I see Dr Nicholson this Thursday and I would like to have a letter to send along with their information.  I had an endoscopy and Upper GI December 2007. I saw my therapist yesterday and she wrote a letter of recommendation.  Their is documentation of prior nutrition, exercise and weight loss programs.   The insurance clerk just wanted to warn me that I have a fight ahead with the insurance company.  They usually do not cover for just a stretched pouch. How do I contat Dr Schlesinger to see if he would write a letter for me? Thank you in advance for your help! Barbara Brewer

Barb I had Dr shopped a while back and found Dr Schlesing to be my best choice  for revision, I actually just came from a appt  to discuss my fears and concerns  - I have a couple items( chest exray, ekg, psych eval )  to get and then we can schedule  my revision date - thinking the vey end of month ..  I got the ins companys criteria and took to Dr Schlesingers office, I had the upper G.I. done and he wrote and submitted for me --- Guess what I am telling you here is that your surgeon is the one to make the case for you !! But the more problems you have the bigger reason you need the revision in oother words  what co morbidities  do you have that have come back ??    I know that with out it - its only a matter of time till , blood sugar , blood pressure and  other problems arise !!!  Hope this helps !

Thanks for your quick reply.  I do have co-morbidities that have returned.  High blood pressure and cholesterol, back and knee pain and I am back on depression.anxiety meds.  So far my blood sugars are okay.  I was just a little upset after talking to Dr Nicolson's insurance clerk.  She said again, that I had a fight ahead of me, especially if they turn me down the first time for a revision!  That is why I was wondering if Dr Schelinger could give me some advice before I go see the Dr Thursday for my consult. Thanks again for your speedy reply! Barbara Brewer

I had the LapBand for 3 1/2 yr's and had alot of problem's with it,,I had a revision,,LapBand removeal and RNY done same day on Feb 18th,,I have UHC,,took 3 weeks for my approveal,,but then again,I had been goin to the doc's for many unfill's and fill's and they had record's of it to send along with the request

Trina, I was denied the first time I tried to get a revision. I have BCBS and my surgeon had to prove that my band was defective and did not work properly. After proving that the band had flipped inside out and had slidden off of my stomach the insurance company approved the revision. I would just like to say, don't give up. It is so worth the fight!!!! This is the best thing that could have ever happened to me! Sonia

Hi Sonia - what type of revision surgery did you have, when did you have it, and how are you doing (if you don't mind sharing, how much have you lost as a result of the revision)? Thanks! Maureen

Hello Maureen,  I went from lapband to gastric. My surgery was done on Feb. 26, 2007. I have lost a total of 115lbs (size 26 to 14). I have felt fabulous since my surgery. This is the best thing that has EVER happened to me........EVER!

Hi,

My insurance paid for my revision from lapband to sleeve. I had chronic problems over a span of almost 5 years though that were health related like reflux, a slipped band, esophageal dialation, pouch dilation, trouble swallowing, achalasia and dysphagia. I was extremely successful with the band, but based on health related issues opted for removal. My BMI almost go back up to 40 and that would have qualified me for a new surgery anyway. It depends on why you want the revision, what insurance you have and what your BMI is at the time you are considering the revision.

Babs in GA
334/225/150