question on revisions

Paula M.
on 6/7/09 11:16 pm - Leesburg, FL
When I had my surgery my husband had insurance that covered the procedure. My doctor who did my insurance however no longer even does them. Too bad cause he is a heck of a doctor. Anyway, my husband's insurance no longer covers gastric bypass because of it.  Now since then our insurance companies have also changed. The hospital my husband works for changed policies. What about my care since I have had it done? Does this company have to honor that when they took over the policy from the hospital? I didn't change, the hospital my husband works for does. So even though this insurance company no longer will do gastric bypass, does that mean, if mines broke they won't fix it? I don't get how that works. There are other doctors I could go to. I truly wish I had the DS cause of my PCO. I think it would have been a better choice because of my insulin resistance and low blood sugar. Its keeping me from losing anymore weight and I have put on 35 pounds and I can't seem to lose anymore. Any suggestions?
Thanks
Paula
smileyjamie72
on 6/8/09 7:19 am - Palmer, AK
The insurance world is SO BIZARRE!!!

Your hubby's job changed policies......  IMO:  Unfortunately, he is stuck.  That is just the way it is, be thankful, you have insurance.  Even if they do not cover as much as they did in the past.

-Jamie

RNY 2/26/2002                           DS 12/29/2011
HW 317                                     SW 263 BMI 45.1
SW 298                                     CW 192 BMI 32.9~60% EWL
LW 151 in 2003  
TT 4/9/2003

Normal BMI 24.8 is my GOAL!!!

 

 

 


 

 

 

GBP (RNY) 2/26/02 298 lbs, TT 4/9/03 151 lbs, DS 12/29/11
HW 317 SW 263 BMI 45.1/CW 192 BMI 32.9/GW 145 ~ Normal BMI 24.8
**Revision Journey started 3/2009 Approved 12/12/11**

Paula M.
on 6/8/09 7:27 am - Leesburg, FL
See what I am also wondering is if say someone had a preexsisting condition and then his company changed insurances wouldn't they make it so there is a preexisting clause on those who already have the current insurance? I would think when buying this policy that the hospital would negotiate things like that. I don't know. I really don't. Insurances are not on our side usually so I figured I would ask. Not sure if I will seek a revision or not. I am just going to try for a bit to lose it on my own. (Like I did that before...NOT)
believe me I am thankful to have insurance. I feel so bad for those who don't. I was thinking that if the insurance company took over for the old insurance company then they got me as I am and that is a gastric bypass surgery patient. They pay for my visits to my surgeon. Anyway, all I could do is call them I guess.
Thanks
Paula
ladydi1970
on 6/8/09 8:50 am - GA
If you had continuing coverage, they MUST cover a pre-existing condition.  Matter of fact, it's not considered "pre-existing" it's considered a continuing condition.

Hope that helps!

But you'd have a bit of a fight on your hands, you'd have to have a Doc that's willing to go to bat and come out and say that your RNY failed and needs to be revised to the DS.  And take it from me, there aren't any that I know of, that's willing to say that point blank.

I'm a revision from RNY to DS....I'd LOVE to have you come over to "the Dark Side"


Diana   DS Revision from '99 RNY 
UHC Denied Jan'09/APPROVED Feb'09 
DS-SW287; CW/190 GW/152



Paula M.
on 6/8/09 10:34 am - Leesburg, FL
Thanks! That is exactly what I was wondering. After listening and reading up on the DS I do feel as though it would have been a better choice for me since I have a history of PCO, insulin resistance and hypoglycemia. I am not sure I would be even considered a canidate but lately I have been gaining and can't get it off. I am told my insulin resistance is back as well. I am hungry almost all the time. I try and try to eat the right things and then when the scale doesn't move it ticks me off. I lost 140 pounds and now have put almost 40 back on! I am angry and mad at myself. I feel like I have no restriction anymore either. I was also going to check into stomaphyx but not sure if my insurance would even take care of that cost either. Anyway, thanks for answering my question. I appreciate it alot!
Paula
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