In the "revision" dump

I have BCBSTX, I've been going through my 6 month diet, which i just found out was changed to 3 months. I've been to the dr. 4 times (so that parts over) i want to get my lapband removed and get the gastic bypass. So I've chosen Dr. Robert Davis from the Davis clinic. Off of "big medicine". Well his insurance person says its harder to get approval for a revision. So she is requesting pw from my previous surgeon. I was banded 5 years ago in 2003. It worked really well. but 2 children later...not so much! So any words of advice on what I should do. Has anyone had this same problem. I just feel like i've gone through so much crap to get denied. That would be a total bummer! Thanks for the help and support. Best wishes to you all!

Hopefully you will not get denied. I think that as long as they have enough documentation it should be fine. I know that with my BCBS of GA ins. it states in the booklet that revisions only require medical necessity. Meeting the BMI criteria and so forth. However it will not cover if the pouch has been streched due to over eating. Check your booklet.However  If you do get denied, you can file appeals with medical documentation showing any types of problems you have encountered with your band. The insurance girls should be able to take care of that part for you. My Dr. office is submitting the paperwork for my revision this week and getting the ball rolling. Lets just pray for each other that we don't get denied so that we can start to be back on the "loser" side of WLS =)  How long after being banded did you get pregnant? I got pregnant 6 months after my surgery and only lost a total of 30lbs...

I waited 2 years before I got pregnant. I lost 124 pounds in two years. But after two babies its just not happening. Its impossible sometimes to find any information out from the actual insurance because you never know whos going to help you. Then at the dr.s office you hear all the ifs ands or buts. i'll keep in you in my prayers! the last time i spoke with someone from bcbs i asked her the req for revisions and she said there arent any, they just need a letter of medical necessity. so hopefully...

Hey!! I am hoping to have a revision to the bypass with dr. Garth!!  I am so excited but I too am worried about the insurance game.  My insurance is a hawaiian insurance.  I just moved here in december.  The insurance girl has been very helpful so I am going to try to be patient but I know how hard it is.  Anyway best wishes to you.  Keep me posted on your journey.

The Davis Clinic is a nice place to be if you want weight loss surgery. Both the Davis's are very nice! Good luck to you!

I will be very interested in what you learn. My RNY was July, 2004. I lost 110 lbs (my goal) then got pregnant about a year later. 3 months after my daughter was born, my brother committed suicide and I lost it. Since then, I have gained back about 40 lbs. (pregnancy weight included) My surgeon is now doing the ROSE procedure and I am just starting to seriously consider this. My main question is about the insurance and if it will cover it. I also have BCBS TX. Keep us posted on what you find out. Good luck!

Jenn

Well you know when you talk to insurance people you never get the same person...the person i talked to said you just needed a letter of medical necessity. I should know something hopefully in a few weeks and I will post when I find out. Good luck to you also!

I just wanted to say that I have Blueshield of California and I did not have to do the supervised diet. My surgeon did watch me carefully for a while, but when I started to gain he submitted the request for a revision. When it was denied by my group plan Blueshield submitted an appeal on my behalf to them and it was approved.

I have BCBS TX also.  I saw Dr. Robert Davis yesterday.  My story is a little different because I haven't gained the 80 lbs back I lost with the Molina band but I have severe reflux at night that wakes me up choking and gasping for air.  It is horrible.  No medications help and he said they won't because the problem is due to the band.  He has recommended revision to bypass.  I was shocked at that since I am no longer considered obese but he says with my history it is indicated to go to bypass as bypass pretty much cures reflux.  I am so grateful to hear that.  I sat with Tamiki yesterday and she called the insurance and it is covered but I will be getting an UGI series so that we can hopefully prove medical necessity and we can get this ball rolling.  I guess one good thing is that I will hopefully drop that last 30 lbs I didn't with the band.  I will keep you posted and can't wait to hear how things progress for you.
Angie

i've gone through so much drama with this! insurance is impossible to talk to. did tamiki tell you that she would have to have all of your records from your previous surgeon. my physician has submitted a letter of medical necessity to her. i don't know if she has submitted it to the insurance or not. its been a long and stressful wait. i had to see a shrink and a nutrionist. i'll be so upset if this gets denied. i've been through so much already. i also have a ugi scheduled for tomorrow! good luck to you Angie. God Bless!