what is criteria to be eligible for RNY to DS revision?

mrsdonvito
on 3/13/10 3:13 pm - sunnyvale, CA
I am 5'4", started at 248, went down to 143, now I am back up to about 180. Does anyone know if that is a significant enough weight gain to be considered for RNY to DS revision, and has anyone had success/failure getting insurance to pay for it? I have anthem blue cross CA, who in 2004 approved without any problem my RNY, but would not cover DS at the time but I have heard that they now do cover it. any info or shared experiences would be very much appreciated! I emailed the surgical group in my area that does the revision, but of course that was friday evening and I want to know NOOWWWW!!!!!
Debbie M.
on 3/14/10 5:39 am
If you're planning to have insurance cover it, have you checked your policy? Typical guidelines are BMI over 40 or over 35 with co-morbidities.  Some insurance policies require a mechanical failure of your original proecedure.

SW 358/CW 201/Goal - anything below 160
Angel to TEAZ (Michelle)

(deactivated member)
on 3/14/10 3:05 pm - Bakersfield, CA
Which surgical group are you looking into?  Is it Rabkin?  I heard he is excellent. 

Yes, unless you are having medical problems associated with it, I doubt your BMI is high enough. I have Anthem bluecross too. So far, I have just been given a list of COE hospitals, but they don't seem to match up with all the DS surgeons.  
(deactivated member)
on 3/17/10 4:05 am - Bayonne, NJ
My BMI had just hit 40, and I had mechanical failure, so I was approved in about 4-5 months. Without mechanical failure my BCBS policy required 6 months of monthly diet & weigh ins with my primary, proof of compliance with the original procedure, and all the same pre-op workups that were required for the initial surgery.
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