BCBS PPO revisions?

I have been researching about a revision from VGB to DS.  I was wondering if anyone has had any luck with BCBS PPO and getting a revision approved.  I was with Cigna HMO until 12/31/08, and any WLS was excluded from our plan.  I am super excited about the insurance changed, and was just curious, because I will not get my insurance card and plan description for a couple of weeks. 

I'm really glad you asked this question- I have the same question. I had RNY 12/2005. I started out at 365 and I am 254 today. I still have another 100 pounds to lose. I am also considering the DS. I just need to have the insurance cover it! Let me know what you find out!! If you want to talk some time please e-mail me.  [email protected]

I'm so glad i'm not the only one who feels like they have failed. My current surgeon has been kind of mean about me wanting a revision. He said "I can't just cut you open every few years when you want to lose a few pounds." So i'm searching for another surgeon.

I had a revision on January 12th (Monday) I had a Lap-band Feb 20th 2007 and started having pain under my left rib about 8 weeks after surgery took my Gallbladder out August 18th 2008 and the pain got worse within 1 week and it was under both ribs. Dr. and I agreed on a revision December 26th 2008 and I wanted the DS and my BCBSM PPO would not cover it because my BMI was still under 50 even tho I was having problems. I had to have the RNY so the insurance would cover it. Im 5 days post op and went to the store today and did some running around feel great!! The only pain Im having is where the port had to come out no pain meds since yesterday.

 I have BCBS PPO.  I had a revision in October.  They paid for my revision.  I just actually got the EOB's in the mail this past week.  I can tell you I was on pins and needles if I would have to self pay because they would not give me prior approval.  Only that it had to be medically necessary and it could not be because I did not loose enough weight with my original wls.

Everyones policy differs as far as coverages and requirements.  I would suggest either calling them to find out what the requirements are for your policy or go on line and see what they list.

Good Luck.

Did you have to go thru a 6 month diet? Did you have any problems with your band? I want to go from lapband to gastric. I also have BCBS PPO TX.

On June 22, 2009 at 9:03 AM Pacific Time, 2BoysMommy wrote: Did you have to go thru a 6 month diet? Did you have any problems with your band? I want to go from lapband to gastric. I also have BCBS PPO TX.  No I did not have to do any of the "hoop" jumping that I did for my first WLS so there was no supervised diet or any of that.  I did not have lap band, my original wls was Proximal RNY.  I revised to ERNY.  I chose not to go to the DS because of the risk factor with taking down your whole pouch.  And just for the record...I did not have to fight with my insurance that much, at the time they just stated that "it had to be medically necessary and would not pre approve me up front".   I wish they would have as it would have taken some of the worry away... I have heard that they have changed some of their policies and that it is even easier now to get approved.  Not sure if this is for all "BCBS" or to what extent it is true.  Just something I have been reading on this board.  

Good luck to you.

Hi There..
         BC/BS does cover revisions. Just Not DS. You could try and fight it.
Four years after my WLS, I started losing again..I lost 50 pounds that year! All I did was added exercise 3 days a week for 30-45 minutes...Weight just started falling off me..I'm talking just step and dancing.. Nothing heavy! I was so surprised...
       DS is so hard to get covered at this time.. but in the next year or so there is a great chance that it will be approved. It will sur pass the RNY I heard. Wishing you the best..Alizka

That statement is incorrect.  I have BCBS PPO and I was able to get approved for my DS without issues.  I made sure I sent loads of documentation to my insurance about the DS not being experimental and I was approved withing 3 weeks.

Hi Jelez,
            I just wanted to mention, If I recall right,  mew6495 did not have a revision to DS. Big difference.. She had an ERNY. Which is covered for the most part by BC/BS. I don't know what health insurance she had.  So that could be the reason she really had to fight for her revision..It is much easier to fight to have another type of revision, like to a ERNY, then to have it done to DS for sure.
     
         I  have BC/BS I called them and asked them about having a revision. They really do not look at past WLS's as revisions if you had  different  health insurance. They look at it as if it was the first WLS. Strange...I even called back and talked to another Rep to see if this was correct. I was told the same thing...
      
        I have also read here that many folks with BC/BS had no problem having their  revision covered. Call BC/BS, they are very helpful! 
     
        I sure hope after my revision, I will not have to go for another revision. What went wrong with your RNY? I'm wondering if it is worth it to go for a RNY...seeing so many people having to have revisions. 
     
      I had my surgery in Feb 1992.. I'm one of the very lucky ones, I only gained back 34 pounds. I never got down to a normal weight. The way they did it way back then was a failure.. It was stomach stapling..The staple lines came opened in over 80% of case's I have heard from many surgeons. 
     Well, I wish you the best, I'm sure it will work out for you.. Alizka

I had BCBS of CA PPO and I was approved for my revision within 3 weeks.  When I submitted for approval I sent a long letter to my insurance explaining my struggles with the band and how the DS was a better choice for me than the RNY.  I was approved with no problems.