I wish i would have had the ds and not the rny

randy S.
on 4/11/11 5:22 am - brooklyn, NY
So its official.  There is an exclusion clause for this revision in my husbands contract for BCBS  Horizon NJ.  Even after they approved the surgery and said it was contractually okay.  Now what the heck do I do.  I am so disappointed.  Got in touch with Walter from Obesity Law and waiting for decision.
Is there someone excellent that does this revision from rny to ds surgery out of the u.s. that I can afford to self pay with.
I am so sad I cant even be mad anymore.
Thanks all!!!Love you guys.  I can always count on you.
(deactivated member)
on 4/11/11 5:37 am - San Jose, CA
What is excluded?  Revisions altogether, or just revision to the DS?  The latter can be fought.

Dr. Ungson in Hermosillo MX does the RNY to DS revision, as does Gagner in Montreal.
(deactivated member)
on 4/11/11 8:07 am - Bayonne, NJ
WTF exclusion? I had Horizon Direct Access BCBS and they did cover my DS revision. Is the exclusion in your policy for all revisions or specifically for the DS???
randy S.
on 4/11/11 8:26 am - brooklyn, NY
Hi baileymouse,
Bariatric surgery is excluded from my policy. But i called to verify i was covered in dec 2010 and was told i was covered for revision and then i proceeded to take care of all other requests bcbs had so i could prove med nes. I even asked what would be coverage if i went out of network. I was planning on going to gagner but turned out 60/40% and he said he would prob do it in 2 parts. So i nixed gagner. And then the story with greenbaum and the infomous erny he insisted was the only revision for me.
I can not believe this happening.
Even if i self pay, the complications that i can have will not be covered.
Words of wisdom would greatly be appreciated right about now. Lol!!!! If i dont laugh i will cry.
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