Revision & Insurance

Hello everybody!  I am a newbie at this but here it goes... I had a RNY in 2002 and went from 305 pounds to approximately 150 pounds.  I have since regained most of the weight and am at 260 lbs.  I am considering a revision but I'm not sure if my insurance will cover a revision.  Has anyone had any experience dealing with insurance companies and revisions?  I currently have Blue Cross Blue Shield.    Any advice?  I can use all of the advice I can get !!  Thanks so much!

I have federal blue cross blue shield and just got approved about a week ago.   If you can prove that there was some kind of mechanical failure to your surgery such as a stretched stoma or stretched pouch and you are having some other kind of problem then they might approve it.  You will need to find a good revision surgeon who will perform an upper GI and endoscopy to see if there are reasons beyond your control for the weight regain.  Hopes this helps.

Thank you for the information!  I am scheduled to see a NP this Tuesday who does the inital consultations for a local Bariatric group.  I hope to get more information at the appointment.  Hopefully they can order the tests for me.   Congratulations on your approval!  Do you have a date set?  I'll try to follow your progress!  thanks again!     

I have BCBS of Georgia and I was approved in 2 weeks although there was a mechanical failure, plus alot of weight gain. When I 1st had my surgery I didnt have a problem being approved, but now things have changed. An upper endoscopy showed I had a fistula and an increased stoma and pouch

How long was it after your original surgery that your doctors found the mechanical problem?  Did you have a RNY originally?  What type of revision did you have done?  Thanks for your help! 

Hey!  I am in your boat - even the same pounds!   What did you find out about BCBS?

I am so glad to hear that i'm not the only one going thru this!  How stressful!  I have my initial appointment tomorrow with the nurse practictioner at the wls surgeons office.  I'll let you know know what I find out.  I'm guessing that i'll have to have further testing to see the status of my pouch and stoma . I'll let you know what the recommendation is and how BCBS will cover.  Are you also anemic after  the surgery? 

I haven't been diagnosed as anemic, but my iron is low and I take supplements now.  I get a lot of bruises.

I am new to this board and am relieved to find that I am not the only one with issues.  I had an open RNY in May of 2000.  Started at 265 and losest weight was about 150 (which family said was too low).  The lowest weight was in about 2003 and I gained about 25 lbs. after that, staying right about 180.  That was fine with me , but then over the past 16 months, I have gained another 40 or so lbs.  I am uncomfortable, having BP issues again, back pain, hip and leg pain,,,yada, yada, yada... So, I spoke with my surgeon and am waiting to see him and have a barium swallow to see if it is caused by a fistula or stretching or what....  I hate to have surgery again, but I don't like this weight.  I also have BCBS in IL.  I hope they will cover it if I need to .. My eating habits have changed too though, I eat more than I ever did and more sweets (rarely dump anymore) and seem to graze. Anyway, I am happy to meet all of you and hope to keep in touch.... Teresa

I had my RNY surgery May 2004 and went from 400 to 250 and worked very hard-exercised every day, watched what I put in my mouth etc.  But in the past year I don't get that full feeling anymore and I don't exercise as aggressively because of knee and foot problems.  So needless to say, I've gained 16 lbs.  I've started researching the new Stomaphyx surgery.  Has anyone out there had this procedure yet?