? about Revision Process

those who've already been revised or got approval already. were you required to go through a 3/6/9/12 month diet/nutrition visit before approval?  Was this by order of the doctor or insurance? also, what testing did your insurance require? I'm in the process and will be having my 3rd nutritional consult with my surgeon's office.  I had my VBG in 1998 and have gained  most of my weight back and my BMI is 41.   I have a call into the office for the results of my Upper GI, I want to know if there is staple line disruption or other complications.  My insurance, Highmark BC/BC won't approve a revision for weight gain only, so there has to be some mechanical failure. Also, if you had a mechanical failure resulting it the need for a revision, what testing did you need and did you need to follow the nutritional counseling? TIA

Hello there! First off, who do you have as an insurance carrier?  That is so important in any part of this process being a first time or a revision.  I have CareFirst and even though I was told on the phone by them that revisions require "serious medical review" all I had to do was follow the steps as though I were a first timer.  I had to have a psych eval, a 6 month structured diet program (working with a trainer counted for me) have a BMI over 40 or have at least one life threatening co-morbidity.  I think that is it.  For me, the process was very easy and I am very happy that I have really good insurance.  I was denied then approved all within 2 weeks.  They denied me because I did not submit my sleep apnea results, once we sent them that they approved me.

thanks for your reply. I have Highmark BCBS PPO and so far everything has been covered with my testing. what was the need for your  revision?  was it weight gain only or were their complications from your original surgery? since my weight regain I have developed Sleep Apnea. As a matter of fact I got my C-PaP yesterday, plus I have reflux. So I do have co-morbidities as well as the requirements for BMI.  I just don't know if I do have to do the other requirements that they have for an initial WLS such as the 6 months and Letter of Medical necessity from my PCP, etc.  I tried calling at lunch but was on hold almost 20 minutes, I have to try again later.

My original surgeon made my pouch too big so it did not benefit me.  You should be able to go to the insurance company's website and go to the policies section and look up gastric bypass/revisions and see what comes up.