APPROVED - Lap Gastric Bypass Surgery Revision from Proximal to Distal

OMG... My Lap RNY Gastric Bypass Surgery Revision from Proximal to Distal has been approved.  

My surgeon's insurance coordinator just called me to tell me the great news.

I made it to goal the first time and was small for years.

My eating is not an issue, but the reason for the revision surgery is a malfunction with my abdomen and my tool (gastro gastric fistula issues).

OMG! OMG! OMG! OMG! OMG! OMG! OMG! OMG! OMG! OMG! OMG! OMG!

I am wigging.....   

I go in on Wednesday for my pre surgery appt and to sign surgery release forms and to get my surgery date.

YEAH!!

 

 

 

I received a similar letter from my insurance company on Saturday.  Now my big roadblock is the copayment required -- $3000.00.

Good luck to you in your revision--

Sue,

Wow congrats on your approval.

What kind of insurance do you have where your copay is $3000.00?

My copay is $100.00.

Thank you for wishing me good luck with my revision.

I wish you the same.

Teena

Ironically, I work for the hospital system where I'll be having my surgery.  When I had my original surgery in 2004, I worked for a single hospital, and the policy in effect at that time covered the surgery without any copays (since I'd met all my yearly deductibles).  Then 3 hospitals joined together and insurance coverage was changed, and now the procedure is covered only for employees (no families) and has the hefty co-pay.  I don't think it is fair that the procedure is singled out, as there aren't such huge co-pays for other surgeries, but there isn't much that I can do to protest.  At least it is a covered benefit.  Some of the tummy tuck after gastric bypass is also covered. 

'm thinking I will have surgery in December, and then will pay the copay by cashing in PTO in January.  Now I have to save PTO so I have enough to cover some time off, too.

Sue O.

Sue,

Even though you will have to wait a lil at least it is still an option for you.

There are so many people who like you and I who do not have insurance or if they do the surgery is excluded so we are truly blessed.

Saving your PTO will be hard, but you know it will be worth it in the long run for a new lease on life.

I wish you well on your journey and keep your head up and be strong.

Keep your eye on the prize.

Teena

Hi Teena,

Who is your insurance company? Do you know what code the surgeon's office used to get approval?
I cannot get BCBS to pay for my surgery for the same fistula issue.

Mel

United Healthcare PPO

CPT CODE 44238

Teena

Thanks!
I will see what your code means.

Mel

Good luck on your surgery. We tried with a very similar code, lap stomach surgery and they denied me. Maybe I need to switch to United Healthcare!

Mel