Revision Requirement Questions
Hello ~
I need a revision to my RnY. The thing is that my insurance company has pre-certed me but I must be on a supervised diet for 3 months before they will authorize me to have the revision.
I know that this is a requirement for many people to have the surgery the first time these days.
My original surgery was done in 1999 so things were very different then. I never had to go through so much to be approved. I'm learning a lot though!
The thing is that I was told that I need to lose "some" weight in these three months. Does anyone have any idea how much "some" might be? They were pretty elusive at the docs office.
Also, my BMI is just 40. At the end of the three months my surgeon has to write the letter of medical necessity for the revision. Will they use my current BMI or my BMI then? If they use the new number I won't qualify. I'm hoping they use the original number.
I have Aetna insurance. Has anyone had a revision with Aetna? How did it go, was the approval easy to get?
I need to have an endoscopy done as well. I'm waiting for that to be scheduled. Hopefully it will be in the next few weeks. My upper GI showed that my stoma is about the size of a quarter and a piece of my intestine is doing something funky. I hope this is enough, along with the weight gain to get approved.
Any info is much appreciated!
Diane
I need a revision to my RnY. The thing is that my insurance company has pre-certed me but I must be on a supervised diet for 3 months before they will authorize me to have the revision.
I know that this is a requirement for many people to have the surgery the first time these days.
My original surgery was done in 1999 so things were very different then. I never had to go through so much to be approved. I'm learning a lot though!
The thing is that I was told that I need to lose "some" weight in these three months. Does anyone have any idea how much "some" might be? They were pretty elusive at the docs office.
Also, my BMI is just 40. At the end of the three months my surgeon has to write the letter of medical necessity for the revision. Will they use my current BMI or my BMI then? If they use the new number I won't qualify. I'm hoping they use the original number.
I have Aetna insurance. Has anyone had a revision with Aetna? How did it go, was the approval easy to get?
I need to have an endoscopy done as well. I'm waiting for that to be scheduled. Hopefully it will be in the next few weeks. My upper GI showed that my stoma is about the size of a quarter and a piece of my intestine is doing something funky. I hope this is enough, along with the weight gain to get approved.
Any info is much appreciated!
Diane
I am scheduled for a revision with Aetna. My original surgery was a VBG (stomach stapling) 22 years ago. Please double check with Aetna. For my Aetna plan, the six- or three-month supervised diet is required for an original surgery but not for a revision. I'd be surprised if it were different for you.
Is this information coming from Aetna or from your surgeon's office?
I realize every company will package Aetna a little differently, but it doesn't make sense that there would be a second tier of qualifications. I suspect you've been given inaccurate information. Or... is this a requirement of your surgeon?
Now, having said that ... it took me at *least* that long to schedule and go through all the testing required... my surgery was 22 years ago. You wanna talk about preparations being different???
~laughing~
Are you revising to a DS? And which surgeon have you chosen?
Is this information coming from Aetna or from your surgeon's office?
I realize every company will package Aetna a little differently, but it doesn't make sense that there would be a second tier of qualifications. I suspect you've been given inaccurate information. Or... is this a requirement of your surgeon?
Now, having said that ... it took me at *least* that long to schedule and go through all the testing required... my surgery was 22 years ago. You wanna talk about preparations being different???
~laughing~
Are you revising to a DS? And which surgeon have you chosen?
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Have you considered the Duodenal Switch? Information is power.
Have you considered the Duodenal Switch? Information is power.
Hmm… one reason your surgeon’s office might give you the three-month diet information is because they’re not used to doing revisions? I’ve not heard of your surgeon, and I’ve done a great deal of research on revision surgeons.
Yes, give
Are you revising to a DS? I’m concerned that I haven’t heard of your surgeon, before. Revisions are so risky, it’s sooooo important to choose a surgeon that has lots and lots of revisions under their belt. Please ask lots and lots and lots of questions. Post on the DS board … it’s a tightly woven group - very knowledgeable and willing to share with others.
If you’re considering an ERNY, **please** do more research! If you asked your surgeon about a DS and he doesn’t perform them, you’ll have gotten either old information of MISinformation … like asking a Ford dealer about buying a Honda.
Best of luck to you! I hope to see you on the DS board!
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Have you considered the Duodenal Switch? Information is power.
Have you considered the Duodenal Switch? Information is power.
I'm going to have another RnY, I'm not interested in DS.
I haven't done enough research on the ERNY, but I don't think I want to go that route.
My surgeon has done revisions before, however he hasn't been in the Lancastre, PA area very long. That may be why you haven't heard any chat about him doing revisions on here.
I haven't done enough research on the ERNY, but I don't think I want to go that route.
My surgeon has done revisions before, however he hasn't been in the Lancastre, PA area very long. That may be why you haven't heard any chat about him doing revisions on here.
On March 31, 2009 at 6:17 AM Pacific Time, dsnydi wrote:
Hello ~I need a revision to my RnY. The thing is that my insurance company has pre-certed me but I must be on a supervised diet for 3 months before they will authorize me to have the revision.
I know that this is a requirement for many people to have the surgery the first time these days.
My original surgery was done in 1999 so things were very different then. I never had to go through so much to be approved. I'm learning a lot though!
The thing is that I was told that I need to lose "some" weight in these three months. Does anyone have any idea how much "some" might be? They were pretty elusive at the docs office.
Also, my BMI is just 40. At the end of the three months my surgeon has to write the letter of medical necessity for the revision. Will they use my current BMI or my BMI then? If they use the new number I won't qualify. I'm hoping they use the original number.
I have Aetna insurance. Has anyone had a revision with Aetna? How did it go, was the approval easy to get?
I need to have an endoscopy done as well. I'm waiting for that to be scheduled. Hopefully it will be in the next few weeks. My upper GI showed that my stoma is about the size of a quarter and a piece of my intestine is doing something funky. I hope this is enough, along with the weight gain to get approved.
Any info is much appreciated!
Diane
Here are Aetna's requirements:
Aetna WLS Requirements
I have United Health Insurance. When the revision from RNy to sleeve/DS was shown to be a need instead of a desire they approved me immediately.
If you have no other 'problems' but weight gain then you may have problems with getting covered. When you said that your scope showed something 'funky'' then that funkiness might be the ticket to instant approval without 3 month diet.
I had severe vitamin deficiency problems (B12 and D and Iron namely) and they found a small fistula (upper stomach connecting to lower) because my stomach was just stapled and I did not have the lower half removed (like my brother and father had when they had thiers done at Mayoclinic) I was a candidate for the sleeve/DS.
I hope that things go your way!
Good Luck!
Christine
If you have no other 'problems' but weight gain then you may have problems with getting covered. When you said that your scope showed something 'funky'' then that funkiness might be the ticket to instant approval without 3 month diet.
I had severe vitamin deficiency problems (B12 and D and Iron namely) and they found a small fistula (upper stomach connecting to lower) because my stomach was just stapled and I did not have the lower half removed (like my brother and father had when they had thiers done at Mayoclinic) I was a candidate for the sleeve/DS.
I hope that things go your way!
Good Luck!
Christine
Strawberry Says, "Take your vitamins Today and be Thankfull Tomorrow!" 
Amy Farrah Fowler
on 3/31/09 7:51 am
on 3/31/09 7:51 am
The revisions I'm familiar with were RNY to DS, but I think the requirements would be the same.
They use the starting BMI, not the post diet BMI. One of the reasons for a pre-surgery diet is to shrink the liver, as it is the first thing to shrink as it dumps it's glycogen stores, and can be in the way for the surgeon, particularly in lap surgery. It's in your best interest to get that liver to shrink as much as possible, since you want your surgery to have as little risk as possible.
They use the starting BMI, not the post diet BMI. One of the reasons for a pre-surgery diet is to shrink the liver, as it is the first thing to shrink as it dumps it's glycogen stores, and can be in the way for the surgeon, particularly in lap surgery. It's in your best interest to get that liver to shrink as much as possible, since you want your surgery to have as little risk as possible.
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