Insurance Coverage

Hello All,

Kinda new to this board.  I has a gastric bypass back i*****  I was 400lbs...I lost 200lbs...and maintained it until just 2 years ago.  I have gained almost 80lbs.  I have United Healthcare Insurance and have been turned down twice by them.  From what they are saying is that the surgery(revision) is experimental; therefore, they will not approve. 

Have anyone other individuals had similar experiences?  Do I need to change my health benefits to another carrier?  My company offers Blue Cross Blue Shield and we choose benefits in Nov.  Therefore, I want to be armed in case I need to switch to have this surgery performed.

Any assistance you guys can provide I would really appreciate it.

Thanks,
Greg

What kind of surgery are you trying to revise to that UHC is saying is experimental?   I have UHC and am having a revision from lapband to VSG on Wednesday.   I was turned down in May 2009 for VSG because at the time they considered that to be experimental.   Then they started covering it in October 2009.   I had no problem this time getting the approval for a revision. 

I would make sure Blue Cross Blud Shield covers the surgery you are wanting to have before you decide to switch.   They might also say its experimental.  Good luck. 

I am hope to have a revision to an old RNY done way back i*****  Any help you could provide would be appreciated.  Maybe my doctor is not wording it correctly and UHC feels it is experimental.  I believe the procedure is called a Stoma-X procedure.

Thanks,
Greg

Stoma-X procedure =  Stomaphyx!!

Search out the old posts about it on this forum.  It doesn't work!  Please don't try and use your REVISION pass with your insurance for this procedure.  It's a HUGE waste of money, time and wear & tear on your body!

Go to a true revision surgeon for an opinion!!!!   I used to work with a surgeon who was doing the stomaphyx.  Not ONE of his patients got any lasting results.  Most would lose a bit in the required "liquid diet" phase post-op and then all would regain. 

Rny revision options: 
1.  an Extended Rny (aka ERny which may or may not include work on your pouch)  They shorten your common channel so you have less absorption........Major complications with a majority!  I would NOT recommend it!
2.  Band over Bypass ...aka BOB.  some have decent ....but s l o w results and it's effectiveness seems minimal .  Bands have more than their share of complications as well.
3.  Stomaphyx or ROSE - tweaking of the stoma to try and reduce the size of theopening.  The theory is that it's a minimally invasive procedure to provide better restriction.  They don't work!
4.  the DS!!!!  BEST results across the board!!!  check out www.dsfacts.com

good luck with your journey!  Don't settle!!!

I have Blue Cross Blue Shield federal (basic option) and had little difficulty getting insurance to approve a revision (approval came within 10 days of being submitted the first time).  I had a RNY back in 2002 or so and my surgeon went in and revised my current RNY just two weeks ago.  Hope that helps.

I'm not familiar with the Stoma-X procedure since I didnt have RNY orginally.  That could be considered experimental by your insurance.   Have you done an appeal, so your doctor can explain to the insurance company why you need this procedure.   Another thing you can consider is using Obesity Law.   I used them on an appeal to get my second lapband and they were great.   Luckily, my revision to VSG was approved on the first try and I didnt have to appeal.  Obesity Law has a website and you can send them your information and they will get back to you with an honest opinion about whehter or not they can help you.   Just a suggestion .

I would check out the DS. You can go to dsfacts.com and also check out the DS forum here.

 Thanks so much.  I am going to do that right now