Revision & Insurance Question??

I know I will have to check with my insurance on what our specific plan covers but in the meantime I was wondering who had their insurance cover their revision after you were a self pay for your original WLS? I have Aetna and know that on certain plans Aetna will pay for WLS. Unfortunately, our plan was one that didn't pay. I've been thinking of a revision but there is no way I could pay out of pocket this time.

Would love to hear from those who have done this and how you got your insurance to pay the second time around?
Thanks

   
             Aetna  paid for my revision, Go online and you can check the criteria and just make sure your employer does not have an exclusion.


I believe they pay for mechanical failure  or if you are 2 yrs + and have had less than 50% of ecesss weight lost . My Dr's office sent in original request - was denied then I sent in appeal and started calling  after 10 days ... Finally got to speak with review persona nd recvd my approval  by end of business day.
 
My first time was paid by another health ins company ( United )

Good Luc****ep us posted

Thank you for the information.  I do believe it was the employer that placed WLS as an exclusion.  This is what I ran into 4 yrs ago and had to pay cash/out of pocket.  It is so frustrating. I eat small amounts (I had the scheletherapy done--spelling??) and this has worked great.  I can tell my pouch is small and my stoma is back to being 10mm but I have gained 35+ pounds and I cannot get rid of it no matter what I do.  I was thinking if in a revision I was bypassed more--since I had a very conservative Proximal. I actually wonder if my dr didn't do a mini bypass??) Anyways, my thought and hopes are that if more is bypassed and with eating small amounts like I am doing I would be able to lose this weight.

It is so depressing.  I was down to a size 6 and now the very few (2 pair of pants) that I held onto that are 14's are tight and very uncomfortable.  At 5' my ideal weight is approx 110 (I am small boned).  I never reached my target weight but I was very happy at a size 6.  Personally, I could care less what the scale says I care how I feel in my clothes and the size. Right now I don't even want to go any place.  I know what people are saying, and yes it could all be in my head, but you know the "look".  Like "oh I knew/heard WLS doesn't work see she gained so much weight back.  I actually had someone come and say wow you've put weight on...you were way to skinny and were smart for gaining some back.  I about died and that was said before I gained even more.  Sorry I am venting.  It has been a really hard week/day.

Any suggestions on how to get around insurance if an employer has wls as an exclusion would be appreciated.  I would also I to hear about the different options for a revision.  If anyone is in the Seattle area and has a great surgeon I need one of those too.  Boy I sound pretty deparate and needy...lol.  My surgeon retired 6 months after my wls.  His advice to anyone who gained back was "you screwed it up---its your fault".  He didn't say that to me but I talked to others he did.

Well thanks for letting me vent.

Contact a good revision surgeon in your area and let them help you. The Ins person can call and get the Skinny on your Ins - Or  you can call ...  Seems that if you have mechanical breakdown and its a required surgery  to repair it - you might have a case .

You might have other issue going on inside as well. Hernia, scare tissue  etc  that is causing some pain and discomfort.

Healthnet medicare HMO paid for my revision. My original rny was denied by United Health Care. I did several appeals and hired a lawyer and still was denied. My Health net does not know that United denied me in 1997. I have the option of changing my health insurance 2 times per year. It was real easy to get approval for my revision. I went online to Healthnet and found all the guidelines myself. Good luck..