Quick Question about Insurance

I got a call from one of the many doctors offices I have call regarding a possible revision of my WLS RNY. I was told that if I wanted to have any kind of revision done a HMO would not approve it the only way I would be able to get a revision maybe would be through a PPO. Has anyone used Blue Cross PPO before and got approved? I have already did the research and have found that I can keep all of my current doctors that I have so that was a plus in changing. The question is will they approve a revision surgery. By the way the name of the facility is Laparoscopic Associates Nicole also told me that most revision surgeries pay for it but she did tell me that since I have insurance I might as well see if they will approve it.   Thanks for you help Sophia

i just got my approval letter today from BCBS of Illinois... i have a PPO as well.

they denied me because they couldnt find the information on my first surgery from 6/02....  My insurance ID number had changed and they didnt bother to run my social security number i take it,

Low and behold yesterday i called them and straightened this whole deal out.  I am lucky.  I am hoping for a surgery date late next month.

What type of revision surgery are you having... Congrads by the way.

I have Aetna HMO and had no problem getting an approval for an RNY to DS revision.

My BCBS HMO approved my  revision from an old VBG (stomach stapling) to a RNY.  My insurance only approved revisions where there is a mechanical failure of the previous surgery.  The old stomach stapling procedure they did back in 1`987 did not stand the test of time and I lost all restriction after the staple line ruptured at some point in the ensuring 22 years. I also had a problem with the mesh they used for the band getting enbedded in my stomach.  These mechanical failures and my weight ( I was at a 50 bmi) - allowed for coverage of the procedure.

The BCBS PPO I used to have (had it at work till it got too expensive and they switched to the HMO) had the same approval policy as the HMO.  Our state BCBS has its medical policy on-line. BCBS vary state to state so I would check and see what the medical policy for bariatric surgery is for your particular insurance.  If you get the insurance for work, be sure to check your particular policy to make sure there are no riders excluding WLS.

Best wishes,

Rhonda

Thanks Rhonda,

I have been speaking more closely with the doctors office and I guess there is a board of some kind in CA. This particular board is who you go to after you have been denied, i guess they are in favor of DS surgery. So I will just have to see what happens. I will check my insurance before i change to someone else.

Sophia