Revision Requirements

I've been trying to find revision requirements and havent had any luck.  Do you know what is "required"?  As I posted in another thread, I called one local dr and they said that weight gain isnt a reason for them to preform a revision, that there has to be a "problem".  Any info would be appreciated.

Generally speaking -

bmi 40+ with no comorbidities
35+ with comorbidities.

Comorbidities = hypertension, sleep apnea, diabeties, etc. something that is considered life threatening.

those apply to a revision. a revision doesn't necessarily mean the surgery came undone. it irks me when doctors put obese people on the spot trying to get them to explain themselves. doctors know but seldom will say that all wls have a life span and then your on your own. a rny lifespan is approximately 3-5 years. hopefully by that time you have made enough changes that you can carry on without it.

Merry Christmas

                                      

 This may depend on what the requirements of your insurance company is.  They vary from one insurance to another.  I would suggest calling your insurance company or go on line and see what they have listed. 

I have BCBS of MI and they covered mine with a BMI under 35.  

Best of luck to you.  Let us know how you make out.

my insurance coverage for revisions was the same for anyone undergoing surgery for the first time, plus a couple of addition requirements.

The surgeon probably is looking for an anatomical reason to revise you.  Most people looking into revisions get an upper GI and endoscopy.  The Dr can see if there is staple line breakdown, a fistula, that kind of thing

good luck

Why are you wanting a revision?  If there is a medical need and your doctor or insurance is the issue for you to complete the revision then you have other options.

Nancy

I have gained lots of weight back since my RNY in 2001.  I did ok maintaining, then seems like in the last 6 months somehting major has changed and I have piled on 30 more pounds!  I am not in pain, but after any meal, I am very bloated and very uncomfortable, not to mention the severe back issues that have reared thier ugly heads since putting weight back on.  I am currently in the process of trying the steroid injections in my back, but so far it has not given me any relief.  I have degenerative Disk disease, I am 35 and my dr said I have the back of a 60 yr old, so the extra weight is an issue in that sense.  I am not sure if there is a medical reason behind the weight gain or not.

My insurance and doctor required me to go through a lot of the same tests as I had to for the first surgery.  It also helps with getting the insurance approval.  I was having issues with my band and vomitting 12 times a week - sometimes more. 

I wish you the best of luck.  It is very frustrating to see the scale moving up after you have worked so hard to get the weight off. 

Hello,

I had to have an upper GI to show staple line breakdown from a VGS from 12 years ago and insurance approved first time around.  My friend who has the exact same insurance (we work at the same company), had the same surgery 12 years ago and the same doctor 12 years ago and today performed that surgery submitted her insurance without the Upper GI and insurance is now requesting more info. 

I have a feeling some insurance might require an Upper GI to show why a revision is required.

My friend and I had the exact same of everything except the Upper GI.

Thanks

Did you have any sypmptoms of something being wrong?  Did you still have to go through all the "stuff"...physc eval, nut, ya know, all those requirements?  Just curious.

Hello,

I was able to eat more than what my "pouch" should allow but at the same time I would occassionally vomit with some food.  Per the surgeon that is a sign there is a staple line breakdown.  Being able to eat more than I should and at other times getting sick. 

To get approved I only needed medical records from my primary doctor and an upper GI.  After I was approved I was told that for the program I needed a Psychological Eval (but was not required by insurance).