Revision with bluecross insurance???

Has anyone with blue cross had a lapband or realize band that has gone for a revision to gastric sleeve or other sugery not do to complications???  Did bluecross make you go through the whole psych eval and 6 months of diet again.  My doctors office is telling me that i will have to do this???  I dont see how when i have had the band for almost 2 years and have failed to loose alot of weight and keep it off. 

Hello -

I have Blue Cross Blue Shield and I was approved for revision.  I am 9 years post-op RNY and revising to DS next month with a different surgeon.  I have had no complications with my RNY but have had a considerable amount of weight gain.

I did have to do the psych eval again.  I haven't had a consistent 6 months of supervised diet, but I was seeing a nutritionist off and on for the past few years.

Hope this helps some!

I am scheduled to have a Revision on June 28th .  I had blue cross the first time and again have it now.  I have had to have the psych eval and a lot more other tests that I did not have to have the first time - but they were required by the doc not the insurance.  As far as Blue Cross/Blue Shield of Illinois, they just want a 'letter' stating that you did have 6 months of supervised diet with your first surgery.  In my case, the surgeon that did my original surgery is no longer practising, but I believe just a letter from the surgeon now will do.  They just want to be told that I completed it the first time.
But, this time I have to have an EKG, Stress Test, Upper GI scope, Sleep Study, had to attend a diet class and an excersize class!! 
But...they say this is all required since it is a revision!
Good Luck!

If you have not already requested a copy of their medical policy regarding the surgery, they are required to provide you with it. It should say exactly what the criteria is. Good Luck, insurance can be soooo tricky sometimes.

Barb

I had BC/BS for my lap-band and they approved it right away.  When I failed to lose weight after being completely filled, I applied for a revision to the DS and they denied it right away saying it wasn't medically necessary.  I appealed 3 times but because there was not technically anything wrong, they refused to approve it.  After talking w/my surgeon we re-submitted the insurance request for just the DS, not the revision part, because I do meet all of the same criteria for just general WLS in general, just not the "revision" aspect of it.  So I am going to self pay just the portion of the removal (idk what that will be yet, yikes) but it was the only way they would approve it.  I just got the approval today :)  I had to do a psych evaluation because it's been longer than 1 year but they didn't make me do the entire behavior modification (7 weeks of psych.) again, just the one visit.  I didn't have to have the 6 month diet thing.  I had my surgeon write a letter saying that having the lap-band IS it's own form of a supervised diet....of sorts.  They accepted that so I didn't argue :)

Good luck!

Unfortunately, I had to delete this post due to privacy concerns.

I agree with Babs talk to your insurance only they can give you a difinitive answer. Good luck!

You know what is interesting about this posting... I never thought about the fact that BC/BS may not pay for the removal of my band...technically there is nothing wrong with it.... besides it is not longer working for me.... but it does say in the wording that revisions are approved as 'medically necessary' ... the removal is not really 'medically necessary'....  I have my full day appointment with Dr Roslin and his staff on 06/01/11 and it will be interesting to see how this plays out.... I qualify in every other way... its just that part that I did not think about... I may have to pay for the removal.... I wonder what the price is on that... is it just an hourly rate... cuz all the rest of it is to preform the DS.... I will def report back with my expirience... Thank you for putting that thought in my head... at least it will not come as a surprise if it happened...