INSURANCE question ...
has anyone been approved within the last 6 months for revision and if so what insurance company did you have? .. or does anyone even know if insurance is covering it, my dr wants me to have it but i would be self pay and no way i can afford it 
please post or email me at [email protected] subject line insurance woes ..
please post or email me at [email protected] subject line insurance woes .. 
I revised from RNY to DS on Dec. 21. I had Horizon BC/BS NJ Direct Access Plan. Dr. Greenbaum was on that particular insurance, so that was a godsend.
BCBS required a 6 month, monthly weigh in with my primary, showing compliance, etc. I had mitigating cir****tances - I had a ring around the stoma that was too tight and it was causing esophageal erosion. I was approved after submitting only 3 months of documentation because of "mechanical failure." I had kept off a little over 100 lbs, I had proof of gym membership and diet, and my endoscopy and upper GI showed the problems.
My total cost for surgery: 5.00 copay and the 250 required by the surgeon's office for shakes and the support group fee.
BTW, right after surgery my company switched to Cigna, and they also cover it. They are a little more stringent about the DS, requiring a 50+ BMI.
BCBS required a 6 month, monthly weigh in with my primary, showing compliance, etc. I had mitigating cir****tances - I had a ring around the stoma that was too tight and it was causing esophageal erosion. I was approved after submitting only 3 months of documentation because of "mechanical failure." I had kept off a little over 100 lbs, I had proof of gym membership and diet, and my endoscopy and upper GI showed the problems.
My total cost for surgery: 5.00 copay and the 250 required by the surgeon's office for shakes and the support group fee.
BTW, right after surgery my company switched to Cigna, and they also cover it. They are a little more stringent about the DS, requiring a 50+ BMI.
Thank you so much! at least it gave me a guideline to go by. I am desperate enough I am seeking a new job to get different insurance, this United Health Care Choice is crap. I just dont get it, if we have surgery the cost it saves them is far outweighs all the meds for all the issues associated with obesity. I have all the information for about a year with all my issues from the surgery under my primary as well as my surgeon, just hoping to get a new job so I can have better insurance. Again thank you so much for giving me a little hope. 
Hi Kathy,
I had a revision this past October from a prior ryn done in 2006. i do have United Health Care Choice Plus and they did cover 100% What can share is please be your own advocate, please never give up and also the key is the surgeon performing the revision will be a HUGE key in proving medicially "wrong" with initial procedure hindering weight loss! Often it takes a little bit of time but is well worth it.
Please keep us informed and keep fighting for YOU!!!
hugggggggggggggggggggs
I had a revision this past October from a prior ryn done in 2006. i do have United Health Care Choice Plus and they did cover 100% What can share is please be your own advocate, please never give up and also the key is the surgeon performing the revision will be a HUGE key in proving medicially "wrong" with initial procedure hindering weight loss! Often it takes a little bit of time but is well worth it.
Please keep us informed and keep fighting for YOU!!!
hugggggggggggggggggggs
hopeful_2ndchance Sandy 
thank you hopeful .. I appreciate you taking the time to respond. Can you give me some tips on where to start? I can obtain my primary care info on the constant yeast infection that seems to re occur every couple of months. Did you have to provide a time guideline, records of weight gain etc ? please put me in the right direction so I know how to go about it. thank you soooo much for any information you can offer. Kathy 
Hi Kathy,
Please forgive my delay as I had a rough week last week. hugggggggggs
Have you consulted with your bariatric surgeon ? Are you planning to use the same surgeon who did your initial surgery?
I did not have the yeast infection and I am sorry you are enduring that , however for me the process was not too difficult. I attended a seminar that US Bariatrics had in my area, this is where I met Dr. Robert Marema. He was not the Doctor that initially did my first surgery (in fact that surgeon you have listed as your Dr. was my first Bariatric Dr) Dr. Marema does specialize in revisions and he had a seminar in my area but He practices primarily out of St. Augustine and Orlando.
All I had to do was have an examination from him, he ordered lab work and an upper GI. Then... the original records from Dr. Jawad's office I had faxed from Ocala Reginal to US Bariatrics. My primary simply wrote an RX stating that he supported my decision for a revision and then I did go for another phych eval. I attended a wonderful class through US Bariatrics and learned sooooo much about nutrition, protien etc and for each of us it is case specific. For myself I had to go through 3 months of iron infusions because I stopped taking bariatric vitaminm
which I will NEVER do again as the Bariatric Vitamins really are made for our bodies! Then Dr. Marmema ordered an endoscopy for me to check everything with a fine tooth comb..
Dr. Marema and his staff did ask me a lot of questions to find out what "bad habits" I may or may not have picked up such as drinking with meals or grazing and then asked me when my regain begain.
I urge you to stress any health issues since regain such as for me I had high blood pressure and lyphedema. Most importantly , communication- keep it flowing with your Doctor's and the insurance.
This support forum and website is the most wonderful thing and there is not a day that goes by that I am not thankful for having all this support but also my 2nd chance.
Please stay in touch and let us know your progree!!!
hugggggggggggggggggggggggs
Please forgive my delay as I had a rough week last week. hugggggggggs
Have you consulted with your bariatric surgeon ? Are you planning to use the same surgeon who did your initial surgery?
I did not have the yeast infection and I am sorry you are enduring that , however for me the process was not too difficult. I attended a seminar that US Bariatrics had in my area, this is where I met Dr. Robert Marema. He was not the Doctor that initially did my first surgery (in fact that surgeon you have listed as your Dr. was my first Bariatric Dr) Dr. Marema does specialize in revisions and he had a seminar in my area but He practices primarily out of St. Augustine and Orlando.
All I had to do was have an examination from him, he ordered lab work and an upper GI. Then... the original records from Dr. Jawad's office I had faxed from Ocala Reginal to US Bariatrics. My primary simply wrote an RX stating that he supported my decision for a revision and then I did go for another phych eval. I attended a wonderful class through US Bariatrics and learned sooooo much about nutrition, protien etc and for each of us it is case specific. For myself I had to go through 3 months of iron infusions because I stopped taking bariatric vitaminm
which I will NEVER do again as the Bariatric Vitamins really are made for our bodies! Then Dr. Marmema ordered an endoscopy for me to check everything with a fine tooth comb..Dr. Marema and his staff did ask me a lot of questions to find out what "bad habits" I may or may not have picked up such as drinking with meals or grazing and then asked me when my regain begain.
I urge you to stress any health issues since regain such as for me I had high blood pressure and lyphedema. Most importantly , communication- keep it flowing with your Doctor's and the insurance.
This support forum and website is the most wonderful thing and there is not a day that goes by that I am not thankful for having all this support but also my 2nd chance.
Please stay in touch and let us know your progree!!!
hugggggggggggggggggggggggs
hopeful_2ndchance Sandy
hello again and thank you soooo much for responding, wow the iron thing .. yes me too!! without stopping my vitamins .. i was already anemic but my issue was the vitamins did not have enough of the iron i needed, i am now on ferretts and i will go to get labs again in 2 months to see if it is up high enough to avoid the iron infusions (the thought alone is scary). i am also having major swelling in my ankles at the end of the day from poor circulation. i have had 2 endoscopy done one 2 years ago with my bariatric surgeon and one with a gastroentologist, that found i have ulcers too. i also have found my new job i went in search of and guess what ... it was the same insurance. i was so disappointed. but you have given me new hope and i will be seeking the surgery in hopes to have it by the end of the year. i would be happy with another 100 pounds. i just want to feel good about myself again and also be able to wear nice clothes. thank you soooo much for the tips and i will definately keep you posted, i am scheduled to start my new job march 15th. kathy hugggggggggggggggggggggs back
you are an
you are an
Hi there Kathy,
Yes we can become very iron deficiant at times even with vitamins and sometimes it is because of taking "short cuts" like over the counter etc but in your case and many others as well as sometimes hereditery , sometimes anemia runs in families too or is caused by other issues.
I can share the iron infusions were not that bad at all, but of course nobody wants to be unhealthy.
I too have poor circulation and have lyphedema so I swell up in my ankles and legs , I can share since my revision... my legs have gone down and the swelling is not as bad.
I do have United Health Care and I had no problem getting approval I think it is all in the "wording" from the Dr. or "patient advocate" that will deem it medically needed as well.
I would call United and talk to them, let them know your health concerns and also call your Bariatric Doctor and ask for assistance in getting the approval.
You have a positive attitude and your determination will carry you!
Congratulations on your new job!!
I wish you the BEST and let me know if I can help you in anyway.
Have a beautiful evening huggggs
Yes we can become very iron deficiant at times even with vitamins and sometimes it is because of taking "short cuts" like over the counter etc but in your case and many others as well as sometimes hereditery , sometimes anemia runs in families too or is caused by other issues.
I can share the iron infusions were not that bad at all, but of course nobody wants to be unhealthy.
I too have poor circulation and have lyphedema so I swell up in my ankles and legs , I can share since my revision... my legs have gone down and the swelling is not as bad.
I do have United Health Care and I had no problem getting approval I think it is all in the "wording" from the Dr. or "patient advocate" that will deem it medically needed as well.
I would call United and talk to them, let them know your health concerns and also call your Bariatric Doctor and ask for assistance in getting the approval.
You have a positive attitude and your determination will carry you!
Congratulations on your new job!!
I wish you the BEST and let me know if I can help you in anyway.Have a beautiful evening huggggs
hopeful_2ndchance Sandy
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