Thinking about revision

I'm looking for some help.  I have an appt with my dr next month to inquire about a revision.  I was banded in 3/09 with little success.  My port flipped 3 months out and had to have that fixed. Now I'm just gaining the weight I lost back!  There is not much that I can eat that doesn't get stuck.  I hate the band and the more I read about it the more I see that it really isn't' a good tool for most. 

I'm looking for advise about revision, if anyone has Horizon BCBS and what would I expect from them regarding approving a revision.  I'm prepared to go through the whole process again and have little hope that it will be an easy process. 

Thanks for your help!

The first thing to do is to look at your health insurance policy and see if they cover revision surgeries.  Some policies now have a 1 surgery per lifetime exclusion.  I have blue cross and the insurance covered mine.  I had my lap band January 2009.  Revised in October 2010.  My insurance policy stated that there had to be a medical reason for revision or that you did not lose so much of a percentage of weight you could revise.  I had severe heart burn and was able to revise.


Tamara

Sometimes the best thing is to chech with your Drs. office to see if revisions have been covered with the type of insurance you have.  Also, check into the excusion policy.

When I dealt directly with the ins. co., I liked to email for answers since they can be very vague on the phone.

I have Cigna, you must meet the following criteria to obtain a revision from them:

Reoperation and Repeat Bariatric Surgery:
Page 3 of 40
Coverage Policy Number: 0051
CIGNA covers surgical reversal (i.e., takedown) of bariatric surgery as medically necessary when the individual develops complications from the original surgery such as stricture or obstruction.

CIGNA covers revision of a previous bariatric surgical procedure or conversion to another medically necessary procedure due to inadequate weight loss as medically necessary when ALL of the following are met:
• Coverage for bariatric surgery is available under the individual’s current health benefit plan.
• There is evidence of full compliance with the previously prescribed postoperative dietary and exercise program.
• Due to a technical failure of the original bariatric surgical procedure (e.g., pouch dilatation) documented on either upper gastrointestinal (UGI) series or esophagogastroduodenoscopy (EGD), the individual has failed to achieve adequate weight loss, which is defined as failure to lose at least 50% of excess body weight or failure to achieve body weight to within 30% of ideal body weight at least two years following the original surgery.
• The requested procedure is a regularly covered bariatric surgery (see above for specific procedures).

NOTE: Inadequate weight loss due to individual noncompliance with postoperative nutrition and
exercise recommendations is not a medically necessary indication for revision or
conversion surgery and is not covered by CIGNA.