Revision Insurance Requirements for UHC choice plus?

Does anyone know the Revision requirements for UHC choice plus? I am asking on behalf of my husband that is seeking an RNY to DS revision.  He had RNY 10/31/06
He  lost from 511 down to 340 and gained to 365 then after major dieting is at 355.
He is still SMO, has high blood pressure, high cholesterol.

For the Revision surgery is there the 6 month of supervised diet requirements? and 5  yrs of Dr. Records?   I dont think he went to any  Dr at all in 2008. 

Thanks for anyones help.

Ami

Every group is different, but mine did not cover DS.

I have my insurance through Apple Inc.

My United Health Care PPO policy

Obesity surgery
Apple's medical covers surgical treatment of morbid obesity provided all of the following are true:

You have a minimum BMI of 40, or 35 with two or more co-morbid conditions are present.

You are over the age of 18 and are physically mature.

You have completed a six month physician supervised weight loss program.

You have completed a presurgical psychological evaluation.

Your surgical services must be approved and provided through the Bariatric Centers of Excellence program.

(None of the above applied to me because I had a mechanical failure per my Nurse Case Manager)

Thank you for your reply.

Our UHC choice plus  policy does cover the DS.. It just covered my virgin DS almost 3 months ago.  My husband is with Plains All American/ Plains Marketing.

I was wondering if the requirements for a revision surgery are the same as the regular Obesity surgery. Such as would he have to do a supervised diet again? among other things.

Our insurance policy did not require that my surgery had to be performed at a centers for excellence hospital. Dr. Stewart is in network for UHC however and the hospital he uses ( 4) depends on the client. For his medicare patients he uses the a centers for excellence hospital but mine was at North Texas hospital. 
      Our dedectable is 300$ then it pays %90 with our out of pocket maximum per year at 1600$ then the insurance pays for the rest of the cost of the surgery/ hospital or whatever else you do medically for the year at %100.

Ami

I honestly think it is easier to get the revision surgery than the original surgery.  Less pre-qual and the surgeon goes in as a "diagnostic laparoscopy" and revises the surgery.  At least that's my experience.  I am scheduled for 2/2/10.

I did not have to do the medically surpervised diet because I had a mechanical failure (a gastro gastric fistula).

I have seen others who had a revision that did not have a mechanical failure have to do the supervised diet.

 Thank you so much for your response.  I am sorry that you had to go through the complication but glad that you were able to get the revision you were seeking. 

 I know that my husbands "stoma" I think it is called is stretched. I wonder if that would be considered to be a mechanical failure ?

Ami

Mechanical failures are caused when the anatomical changes made during the original bariatric surgery, are not maintained. Examples of these changes are as follows:

• the pouch may stretch and become larger
• the outlet of a gastric pouch may increase in diameter 
• a gastro-gastric fistula may form between the gastric pouch and the bypassed stomach
• the intestine may increase its absorptive abilities beyond what was expected
• restriction may decrease as a result of a band slippage

 Thank you!.
 I do believe that my husband may qualify under a mechanical failure aspect to forgo some of the virgin WLS steps.  I know he will have to have an upper GI,  and some other tests for our surgeon to evaluate but this is very hopeful and could get us looking at him having surgery in the new year as opposed to the summer time due to the 6 month diet. 
I really appreciate you taking the time to answer my questions.

Ami

No worries.

Good luck.

Teena,

Glad to see you are out and about and get with the business of losing.. You go Girl!!!!!! So are you saying that a stretch pouch may be considered mechanical failure? 

Sophia