Revision in CA.....InsuranceCoverage???

I've posted before a few months back, I have Kaiser insurance but they are a pain so now I am changing my insurance coverage effective January to Blue Cross.  Do they cover any type of revision in California?  I have had a gastric bypass 10 years ago at 281lbs, initially lost about 100lbs but now have gained it all back.  Never got to "goal" weight and was never really happy that I couldn't get off more weight, but still glad that I was healthy.
Now I am researching possibilities of revision.  Last time I posted all that was mentioned was DS everywhere.  I don't know what is covered by insurance or what options are out there.  I was reading about the band being an option, but I am such a newbie again...  It's exciting to be back on the path, scary to think I could be knocked down with no insurance coverage though...
Help!!

Mandy

 
Nobody can really answer your question and i'll explain why.  All ins co's offer WLS but it is an extra premium for group policies and most employers are trying to save money and they are dropping the WLS benefits.  So while your ins does offer WLS benefits you need to find out if your employer purchased the rider.

Some ins co's have a 'one WLS in a lifetime' added to their policies.

If it is a private policy, no.  They will not offer WLS.  Too many people would get a policy long enough to get surgery and then drop the policy.  Nobody could afford that.

Revision from bypass to DS does offer the best long term weight loss but it's a riskier surgery. Revision from bypass to band offers the least weight loss and highest regain but it is a safer surgery.  ROSE and Stomaphyx do not work at all.  ERNY is kinda dangerous with a lot of complications and it's just going to buy you a few more months of weight loss and you'll be back to where you started from.

There is a great deal to consider.

Hi there Mandy,
I had my revision covered by BCBS with Dr. Keshishian in CA.  Each policy is unique though, based on the Employer's package.  Some policy's will say they do NOT cover a revision and allow for ONE weight loss surgery in a lifetime. ....That was the case with mine.  I was denied twice before my approval.  ....The thing about revisions is that few are based on the original criteria of just having the right BMI, co-morbidities, etc.  Most revisions fall into the category of being "medical necessity" which pushes past the basic WLS guidelines.

Your surgeon's office can guide you and once you have the insurance in January, you can go on-line and get the exact basics.  Don't give up though if it's "not covered" or if it's "denied".  Many decisions can be overturned with appeals.

Good luck!!!!

Mandy,

I have Blue Shield of CA and revision are covered, however, it depends on your policy. In my policy it says you must prove mechanical failure of the original RNY proceedure and this can come in may forms. What I would do I make an appointment with your new pcp and then ask for an Upper GI to be done and a referral to see a surgeon.

I am currently waiting on my approval for revision to DS as it yeilds the best results as far as a WLS is concerned. No one told me a thing about it so now I want the best that I can get. Good luck to you.

Sophia