"Officially Submitted Into The Insurance"
X-POSTED on DS messageboard too
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OK, we have submitted for my RNY to DS revision!!!!!! It was submitted sometime last week.
YAY!!!! I cannot tell you how excited I am!!!
a) Primary will come through with a denial, there is NO SUPRISE there. It is a self-funded insurance. And, even if I were to appeal, the answer would still be a denial.
b) Secondary, well, we will be hearing about the answer soon!! I'll tell you what I know, first-hand.
***This post is in my blog, under April 2009, I called the insurance companies personally:
I called my insurance companies and and asked a "general" question about coverage for bariactric revision surgery: The primary says: "non-surgical or medical necessity for coverage." The secondary says: "actually excluded in the plan" And she went on to say to definately submit the co-pays into them, they still might cover some of the expenses. ***Since I was the one that called {I have no insurance background, so I was not sure how to ask the questions, or even which ones to ask!!}***
***This post is also in my blog, under May 2009... My revision surgeon's office called my insurance companies:
"I did receive you inquiry and was able to verify your eligibilities and coverage with both insurances. Here is what I found out: your primary insurance states that they do not cover any surgical weight loss treatment, and when I asked your secondary about surgical weight loss treatment they said it is a case-by-case review and precertification is needed."
***This post is also in my blog, under August 2009... My revision surgeon's office called my insurance companies:
Also, I contacted your insurance and secondary says it is a covered benefit but primary still says no surgical coverage. We will submit and see.
OK, now I will wait my 30 days, and keep my fingers crossed.... and update as soon as I hear something!!!!!!
Thank You for your contiuned support, 
and all of the excellent information on this board!!!!!-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**
I will keep you in my prayers.
Facebook Contact Info/Email address:Skyedan[email protected]
10/09/09 - Distal Gastric Bypass (ERNY) Revision - Common Channel 90
"Never Let People,Places,Or Things Stand In Your Way Of Fulfilling Your Goals And Living Out Your Dreams." Teena Adler
Good Luck in your continued/////////FRUSTRATING journey as well.
-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**
With how I perceive the "conflicting" information from the insurance company, it is hard to get my hopes too high!!
-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**
